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Having a Beer After SVR

Nicole Cutler L.Ac. August 29, 2014

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After surviving the diagnosis, illness and treatment for Hepatitis C, those who are cured of this illness may once again be faced with a decision to drink alcohol.
Having a Beer After SVR

The first instruction typically given to anyone diagnosed with Hepatitis C is to abstain from drinking alcohol. This is logical, since Hepatitis C is a viral infection of the liver and alcohol is a known liver toxin. In order to prevent Hepatitis C from escalating to an advanced form of liver disease, those with this infection must squelch any desire to consume a beer, glass of wine or other intoxicating spirit. Completing antiviral therapy and successfully conquering the Hepatitis C virus definitely hinges on a commitment to avoid alcoholic beverages.

However, does the same rigid rule apply after successful elimination of this virus?

The Hepatitis C virus has proven itself to be a formidable foe. Hepatitis C:

  • can persist for several decades in the body without revealing any symptoms despite progressively injuring the liver.
  • can eventually produce vague symptoms like fatigue, depression, joint pain and sexual dysfunction.
  • puts those infected at risk for liver fibrosis, cirrhosis, liver cancer and liver failure.
  • has demonstrated extreme resilience to medical treatment, complicating the campaign to end its destruction.

Treatment and SVR

Today, Hepatitis C antiviral therapy has evolved to consist of a combination of medications taken from 24 to 48 weeks. With triple drug therapy, the success rate of clearing the virus has risen from approximately 50 percent up to 75 percent. However, new pharmaceuticals in development promise to eliminate Hepatitis C in 8 to 12 weeks with a 90 percent or higher success rate.

A successful Hepatitis C outcome is defined as SVR, or sustained virologic response. An SVR is attained when genetic material of Hepatitis C is undetectable six months after therapy is completed. The equivalent of becoming Hepatitis C negative, SVR greatly improves liver function, life expectancy and quality of life.

According to Sanjeev Arora, MD, a professor of internal medicine at the University of New Mexico Hospital Center for Digestive Diseases, “In general, once an SVR is attained (sic), the liver disease progression completely stops.” Although SVR is cause for celebration, becoming Hepatitis C negative does not completely remove the risks of future liver disease complications.

Alcohol and Hepatitis C

There is no doubt that drinking excessive quantities of alcohol harms the liver. A large study published in a 2004 edition of the journal Hepatology clarifies that any amount of alcohol can harm someone with Hepatitis C. Based on this study of 800 people with Hepatitis C, researchers found that, while heavy drinking was linked with more severe liver problems, there was no “safe” level of drinking for people with this virus.

The medical community has recognized that alcoholic beverage consumption accelerates the progression of liver fibrosis with chronic Hepatitis C. The reasons are fourfold. Alcohol:

  1. enhances Hepatitis C viral replication.
  2. increases oxidative stress.
  3. induces cytotoxicity (cell death).
  4. impairs the immune response.

Despite knowing that alcohol fans the flames of liver injury and negatively affects overall health, many who have recently attained SVR are hoping to finally be able to enjoy an alcoholic beverage.

Alcohol After Hepatitis C

All of the reasons given for abstaining from alcohol with Hepatitis C are still valid – even after eliminating the virus from the body. The viral particles may no longer be present, but alcohol will still pose a threat to the liver’s health. During the course of time someone was infected with Hepatitis C, damage to the liver could range from minimal to severe. Those who escaped with little liver damage have a better prognosis than the majority who lost functioning liver cells:

  • The good news is achieving SVR appears to stop the progression of liver disease.
  • The bad news is alcohol consumption injures the liver – thus putting remaining liver cells at risk of damage.

To date, there have not been any comprehensive studies on the effect of alcohol post SVR. Though, having an alcoholic beverage with any level of liver damage is a gamble.

There are several variables in deciding the relative safety in this indulgence:

  1. Liver Disease Severity – Those with liver disease that advanced beyond mild fibrosis are taking a risk by drinking alcohol. After all of the effort invested in defeating Hepatitis C, an occasional glass of wine has the potential to cause the same type of damage as the ousted virus.
  2. Alcohol Dependence – For some with Hepatitis C, abstaining from drinking alcohol is a challenge due to some level of addiction. Returning to its consumption can easily trigger an addiction relapse. Such a relapse can lead to excessive drinking which is dangerous for anyone – especially someone who has a liver recovering from Hepatitis C infection.
  3. Questionable Degree of Liver Damage – After attaining SVR, few physicians will advise a liver biopsy. Thus, it is difficult to determine the degree of liver damage. Because of this uncertainty physicians typically advise those who have beaten Hepatitis C to continue with alcohol abstinence.

Even with all of the evidence just presented, there may be some individuals who have attained SVR from Hepatitis C and still want to drink alcohol. Ideally, this should be discussed with a medical provider to be certain that alcohol won’t jeopardize that person’s health.

Everyone’s ability to handle alcohol is different. Although excessive alcohol consumption is nearly guaranteed to cause liver harm, light drinking (no more than two drinks per week) might be okay for some. On the other hand, a significant amount of liver scarring or other health issue could render having an occasional beer to be a high risk activity.

If you have beaten the Hepatitis C virus and have no detectable liver injury from the virus, then one glass of wine per month is probably okay. However, putting alcohol back into the playing field for anyone else that achieved SVR is risky. To sum up, a tremendous effort was made by those who conquered Hepatitis C – an effort that could be wasted by choosing to consume alcohol, a known liver toxin.

http://cid.oxfordjournals.org/content/early/2013/04/23/cid.cit234.abstract, A risk for hepatocellular carcinoma still persists long-term after sustained virological response in patients with hepatitis C associated liver cirrhosis, Aleman S, et al, Retrieved August 23, 2014, Clinical Infectious Diseases, April 2013.

http://www.ncbi.nlm.nih.gov/pubmed/14999703, Risks of a Range of Alcohol Intake on Hepatitis C-Related Fibrosis, A. Monto, et al, Retrieved August 24, 2014, Hepatology, March 2004.

http://www.healio.com/infectious-disease/gastrointestinal-infections/news/online/%7B5a089979-a1f9-44b9-a762-ee3524e707d1%7D/hcc-risk-persists-8-years-after-hcv-eradication, HCC Risk Persists 8 Years After HCV Eradication, Alemana S., Retrieved August 23, 2014, Healio, 2014.

http://www.hcvadvocate.org/hepatitis/factsheets_pdf/HCV_Neg.pdf, HCV Negative: A Guide for Healthy Living without Hepatitis C, Lucinda K. Porter, RN, Retrieved August 23, 2014, Hepatitis C Support Project, 2014.

http://www.hepatitiscentral.com/mt/archives/2011/02/another_reason.html, Another Reason for Hep C Patients to Abstain From Alcohol, Nicole Cutler, L.Ac., Retrieved August 24, 2014, Hepatitis Central, 2014.

http://www.hepmag.com/articles/Post_SVR_2502_24227.shtml, Past the Finish Line: The Benefits of a Hepatitis C Cure, Benjamin Ryan, Retrieved August 23, 2014, CDM Publishing, LLC, 2014.

http://www.thebody.com/Forums/AIDS/Hepatitis/Q207770.html, Consumption of Alcohol After Treatment of Acute Hepatitis C, Barbara McGovern, MD, Retrieved August 23, 2014, TheBody.com, 2014.

http://www.webmd.com/hepatitis/news/20040312/bad-mix-alcohol-hepatitis-c, Bad Mix: Alcohol and Hepatitis C, Jeanie Lerche Davis, Retrieved August 23, 2014, WebMD, LLC, 2014.

http://www2.potsdam.edu/alcohol/InTheNews/MedicalReports/Cancer/Alcohol-and-Liver-Cancer.html#.U_oJdUu4nlI, Alcohol and Liver Cancer, David J. Hanson, PhD, Retrieved August 24, 2014, DJ Hanson, 2014.

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