HCV, alcohol, and the liver

Abstract

Alcoholic liver disease (ALD) and hepatitis C virus (HCV) infection together account for the greatest causes of liver disease in patients worldwide. It is estimated that about 140 million and 170 million individuals worldwide suffer from alcohol dependence or chronic HCV infection respectively. ALD and HCV infection, independently, if not treated properly can progress to advanced liver disease including fibrosis, cirrhosis and ultimately hepatocellular carcinoma (HCC). Their synergism, however, has been shown to dramatically exacerbate the rapid progression of liver disease to HCC. Several molecular mechanisms representing synergistic interactions of HCV and alcohol that accelerate the progression of liver disease have been identified including immune, metabolic, oxidative stress, proteomic and epigenetic modulations of target host systems. In this review, we summarize current advances in understanding of the various molecular cellular mechanisms by which HCV synergizes with alcohol to advance liver disease. Given the limited treatments available for HCV-infected patients who use alcohol, we also highlight new therapeutic targets and areas where more research would enhance our understanding of the pathophysiology of this disease. At this point in time, we recommend that HCV-infected patients should abstain from drinking alcohol and that those who abuse alcohol should be encouraged to stop alcohol use and be tested for HCV infection.