Novo-Veleiro I, Alvela-Suárez L, Chamorro AJ, González-Sarmiento R, Laso FJ, Marcos M. Alcoholic liver disease and hepatitis C virus infection. World J Gastroenterol 2016; 22(4): 1411-1420 [PMID: 26819510 DOI: 10.3748/wjg.v22.i4.1411]
Corresponding Author of This Article
Miguel Marcos, MD, PhD, Assistant Professor, Alcoholism Unit, Department of Internal Medicine, University Hospital of Salamanca, Institute of Biomedical Research of Salamanca-IBSAL, Pº San Vicente, 58-156, 37007 Salamanca, Spain. mmarcos@usal.es
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Topic Highlight
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Ignacio Novo-Veleiro, Lucía Alvela-Suárez, Department of Internal Medicine, University Hospital of Santiago de Compostela, 37007 Salamanca, Spain
Ignacio Novo-Veleiro, Antonio-Javier Chamorro, Francisco-Javier Laso, Miguel Marcos, Spanish Working Group on Alcohol and Alcoholism, Spanish Society of Internal Medicine, 28016 Madrid, Spain
Antonio-Javier Chamorro, Francisco-Javier Laso, Miguel Marcos, Alcoholism Unit, Department of Internal Medicine, University Hospital of Salamanca, Institute of Biomedical Research of Salamanca-IBSAL, 37007 Salamanca, Spain
Rogelio González-Sarmiento, Miguel Marcos, Molecular Medicine Unit, Department of Medicine, University of Salamanca, Institute of Biomedical Research of Salamanca-IBSAL, 37007 Salamanca, Spain
Author contributions: Novo-Veleiro I, Alvela-Suárez L and Chamorro AJ carried out the literature research and drafted the manuscript; Novo-Veleiro I, Laso FJ, González-Sarmiento R and Marcos M contributed to manuscript conception and design; all authors approved the final version of the manuscript; Laso FJ and Marcos M contributed equally as senior authors of this manuscript.
Supported by the Spanish Ministry of Science and Innovation, Instituto de Salud Carlos III and the European Union FEDER funds, Una manera de hacer Europa (in part, grant No. PI10/01692 and No. I3SNS-INT12/049 to Marcos M); and the Red de Trastornos Adictivos-RTA (grant No. RD12/0028/0008 to Laso FJ).
Conflict-of-interest statement: Marcos M has received advisory board honoraria from Lundbeck.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Miguel Marcos, MD, PhD, Assistant Professor, Alcoholism Unit, Department of Internal Medicine, University Hospital of Salamanca, Institute of Biomedical Research of Salamanca-IBSAL, Pº San Vicente, 58-156, 37007 Salamanca, Spain. mmarcos@usal.es
Telephone: +34-923-291100-437 Fax: +34-923-294739
Received: April 28, 2015 Peer-review started: May 6, 2015 First decision: August 31, 2015 Revised: October 1, 2015 Accepted: November 30, 2015 Article in press: December 1, 2015 Published online: January 28, 2016 Processing time: 267 Days and 9.9 Hours
Abstract
Alcohol consumption and hepatitis C virus (HCV) infection have a synergic hepatotoxic effect, and the coexistence of these factors increases the risk of advanced liver disease. The main mechanisms of this effect are increased viral replication and altered immune response, although genetic predisposition may also play an important role. Traditionally, HCV prevalence has been considered to be higher (up to 50%) in alcoholic patients than in the general population. However, the presence of advanced alcoholic liver disease (ALD) or intravenous drug use (IDU) may have confounded the results of previous studies, and the real prevalence of HCV infection in alcoholic patients without ALD or prior IDU has been shown to be lower. Due to the toxic combined effect of HCV and alcohol, patients with HCV infection should be screened for excessive ethanol intake. Patients starting treatment for HCV infection should be specifically advised to stop or reduce alcohol consumption because of its potential impact on treatment efficacy and adherence and may benefit from additional support during antiviral therapy. This recommendation might be extended to all currently recommended drugs for HCV treatment. Patients with alcohol dependence and HCV infection, can be treated with acamprosate, nalmefene, topiramate, and disulfiram, although baclofen is the only drug specifically tested for this purpose in patients with ALD and/or HCV infection.
Core tip: Alcohol favors hepatitis C virus (HCV) replication and diminishes immune response against it, increasing the risk of advanced liver disease. HCV infection prevalence among alcoholics, initially thought to be much higher (up to 50%) than in the general population, has been reported to be lower in recent studies. Intravenous drug use and advanced alcoholic liver disease may confound the prevalence of HCV infection among alcoholics. Before starting HCV infection treatment, patients should be screened for alcohol use disorder and abstinence should be achieved. Baclofen may be the drug of choice for patients with alcohol dependence and advanced liver disease.
