The interesting study by Younossi et al.[1] demonstrates that patients with chronic hepatitis C (CHC) are at increased risk of both liver-related mortality and overall mortality, and this risk increased in CHC patients who consume alcohol excessively (20 g/day or greater). Several studies have been focused on CHC patients consuming alcohol, analysing viral replication, therapeutic response or liver damage.[2-10] We studied the prevalence of lesions compatible with alcohol intake (LCAI) in liver biopsies obtained from 62 CHC patients treated 48 weeks with pegylated interferon (PEG-IFN) plus ribavarin (RBV).

All 62 patients (49 males, 79%), consumed at least two glasses of red wine daily (<20 g/day) and had a pre-treatment liver biopsy. LCAI scoring: steatosis, Mallory bodies, megamitochondries, polymorphonuclear infiltrate, perivessel fibrosis and siderosis; parameters scored as: 0: none, 1: mild, 2: medium, 3: moderate and 4: severe. Biopsies were evaluated (METAVIR) by a single expert pathologist. Biochemical and virological data were also assessed.

Lesions compatible with alcohol intake were detected in 54/62 patients (87%): 46 steatosis, 3 megamitochondries, 2 Mallory bodies, 41 polymorphonuclear, 42 perivessel fibrosis, and 28 siderosis. Patients with LCAI (n = 54) demonstrated higher gamma-GT levels than those without (n = 8): 72 ± 51 vs. 34 ± 33 U/L, respectively (P < 0.05). No differences were found regarding viraemia (1 024 629 ± 916 092 vs. 748 750 ± 415 982 IU/mL, respectively; P = 0.4), AST (74 ± 47 vs. 63 ± 71 U/L, respectively; P = 0.5) or ALT (124 ± 93 vs. 121 ± 133 U/L, respectively; P = 0.9). Patients with LCAI showed more advanced fibrosis (F3-F4), not reaching statistical significance (37% vs. 25%; P = 0.7). All patients completed therapy and follow-up period: the global sustained virological response rate was 46.8% (29/62), in the LCAI group 46.3% and 50% in the non-LCAI group (Table 1).

Table 1. Parameters scored and compared in 62 treated chronic hepatitis C patients
  1. LCAI, lesions compatible with alcohol intake; SVR, sustained virological response.

Gamma-GT72 ± 5134 ± 33<0.05
Viraemia1 024 629 ± 916 092748 750 ± 415 982NS
AST74 ± 4763 ± 71NS
ALT124 ± 93121 ± 133NS
Severe steatosis33%25%NS

In summary, a high prevalence of LCAI was found in CHC patients consuming moderate amounts of red wine. LCAI were associated with higher serum gamma-GT levels and these patients had increased hepatic fibrogenesis. Noticeably, the presence of LCAI did not predict a worse therapeutic response to PEG-IFN plus RBV.


  1. Top of page
  2. Acknowledgement
  3. References

Declaration of personal and funding interests: None.


  1. Top of page
  2. Acknowledgement
  3. References
  • 1
    Younossi ZM, Zheng L, Stepanova M, Venkatesan C, Mir HM. Moderate, excessive or heavy alcohol consumption: each is significantly associated with increased mortality in patients with chronic hepatitis C. Aliment Pharmacol Ther 2013; 37: 7039.
  • 2
    Ohnishi K, Matsuo S, Matsutani K, et al. Interferon therapy for chronic hepatitis C in habitual drinkers: comparison with chronic hepatitis C in infrequent drinkers. Am J Gastroenterol 1996; 91: 13749.
  • 3
    Ostapowicz G, Watson KJR, Locarnini SA, et al. Role of alcohol in the progression of liver disease caused by hepatitis C virus infection. Hepatology 1998; 27: 17305.
  • 4
    Yoshihara H, Noda K, Kamada T. Interrelationship between alcohol intake, hepatitis C, liver cirrhosis and hepatocellular carcinoma. Recent Dev Alcohol 1998; 14: 45769.
  • 5
    Khan KN, Yatsuhashi H. Effect of alcohol consumption on the progression of hepatitis C virus infection and risk of hepatocellular carcinoma in Japanese patients. Alcohol Alcohol 2000; 35: 28695.
  • 6
    Hutchinson SJ, Bird SM, Goldberg DJ. Influence of alcohol on the progression of hepatitis C virus infection: a meta-analysis. Clin Gastroenterol Hepatol 2005; 3: 11509.
  • 7
    Tanaka K, Tsuji I, Wakai K, et al. ; ResearchGroup for the Development and Evaluation of Cancer Prevention Strategies in Japan. Alcohol drinking and liver cancer risk: an evaluation based on a systematic review of epidemiologic evidence among the Japanese population. Jpn J Clin Oncol 2008; 38: 81638.
  • 8
    Innes HA, Hutchinson SJ, Barclay S, et al. ; Hepatitis C Clinical Database Monitoring Committee. Quantifying the fraction of cirrhosis attributable to alcohol among chronic hepatitis C virus patients: implications for treatment cost-effectiveness. Hepatology 2013; 57: 45160.
  • 9
    Le Lan C, Guillygomarc'h A, Danielou H, et al. A multi-disciplinary approach to treating hepatitis C with interferon and ribavirin in alcohol-dependent patients with ongoing abuse. J Hepatol 2012; 56: 33440.
  • 10
    Costentin CE, Trabut JB, Mallet V, et al. Management of hepatitis c virus infection in heavy drinkers. Alcohol Alcohol 2013 [Epub ahead of print].