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Viral Hepatitis and Liver Disease

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Alcohol and Viral Hepatitis

for Health Care Providers

Hepatitis C and Alcohol: An Overview - Hepatitis C

When counseling a patient with hepatitis C, always evaluate the patient's history of and current use of alcohol. Generally speaking, alcohol is a toxin that causes inflammation of the liver. When both alcohol and viral hepatitis are present, they can have a synergistic effect in causing liver damage. Research has shown that fibrosis scores in hepatitis C patients have correlated with patients' degree of alcohol use. There is strong evidence that heavy alcohol use (>50 grams per day) is associated with higher likelihood of advanced fibrosis in hepatitis C patients. Reducing and minimizing alcohol intake is one thing that patients with hepatitis C can do in their lifestyle to help reduce the progression to serious liver disease. However, controversy exists on the question of what amount of alcohol is safe in patients with hepatitis C.

Assessing patients true degree of alcohol use can be difficult. Observational studies of alcohol and viral hepatitis can be flawed because of patients' self-reported alcohol intake. Patients are often inaccurate in their estimate or their recall, or are often not willing to report their true alcohol intake. It is best to be very specific when discussing alcohol recommendations. What one person considers "rare" use of alcohol, another patient may consider "frequent." The Alcohol Use Disorders Identification Test (AUDIT-C)Link will take you to our Viral Hepatitis and Liver Disease internet site can help identify patients with hazardous patterns of alcohol consumption or active alcohol use disorders (including alcohol abuse or dependence).

It is important to note:

  • Alcohol abstinence is not a prerequisite for initiation of hepatitis C treatment.
  • For patients with cirrhosis, due to hepatitis C or any other cause, there is a clear recommendation for zero alcohol consumption.
  • For patients with hepatitis C and lower levels of fibrosis (F0-F2), the safe level of alcohol intake is unclear. Less alcohol is generally safer, but a cutoff has not been established. The most important message for patients is that alcohol can worsen their liver disease. Recommending minimal alcohol is usually reasonable.
  • After hepatitis C treatment, providers should discuss alcohol use again once a patient has achieved a sustained virologic response (SVR). Due to residual liver fibrosis, patients should continue to be very cautious with alcohol use even after SVR. Providers should recommend minimal alcohol use in patients without cirrhosis and zero alcohol use in patients with cirrhosis.
  • There is a high prevalence of drinking among patients with hepatitis C. Collaborate with local substance abuse clinics and mental health providers to address this critical component of viral hepatitis patient care.


AASLD Guidance on Alcohol-Associated Liver DiseasesLink will take you outside the VA website. VA is not responsible for the content of the linked site.

VA Substance Use Disorder Program Locator