Wieland Amanda, Everson Gregory T
Department of Internal Medicine, Section of Hepatology, Division of Gastroenterology and Hepatology, School of Medicine, University of Colorado Denver, 1635 Aurora Court, B1-54, Aurora, CO 80045, USA.
Alcohol Alcohol. 2018 Mar 1;53(2):187-192. doi: 10.1093/alcalc/agx101.
To provide an overview of published literature on the interaction of alcohol and hepatitis C virus (HCV) in the accelerated progression of liver disease to cirrhosis as relates to decision-making for the management of the liver transplant candidate and recipient.
General PubMed search was employed along with expert input to identify the relevant articles on the topic. The authors also utilized both backward and forward citation review of the relevant articles and reviews to identify articles on identified topic.
In HCV cases, heavy alcohol use has been associated with more severe fibrosis, but even low rates of use may have deleterious effects. Patients with chronic hepatitis C and alcoholic liver disease can be cured of the HCV-theoretically positively impacting outcome and reducing the need for liver transplantation. Current antiviral therapy achieves virologic cure or sustained viral response (SVR) in over 90% of cases. Antiviral therapy is so effective that most liver transplant candidates or recipients can be cured of HCV either prior to or after transplantation. However, despite successful antiviral therapy, liver disease may progress after SVR due to the effects of ongoing alcohol use.
Antiviral therapy in patients with HCV plus alcohol should improve pre- and post-transplant outcomes, but providers must remain firm in limiting use of alcohol to avoid progression of liver disease post HCV cure.
Abusive alcohol use and chronic hepatitis C virus (HCV) commonly co-exist and both need to be addressed in liver disease. With high rates of HCV cure with new therapies, attention needs to turn toward ongoing abusive alcohol patterns that may determinately impact liver health both before and after liver transplant.
概述已发表的关于酒精与丙型肝炎病毒（HCV）相互作用在肝病加速进展至肝硬化过程中的文献，这与肝移植候选者和接受者的管理决策相关。
采用一般的PubMed搜索并结合专家意见来识别该主题的相关文章。作者还对相关文章和综述进行了追溯和前瞻性引用回顾，以识别关于已确定主题的文章。
在丙型肝炎病例中，大量饮酒与更严重的纤维化相关，但即使少量饮酒也可能产生有害影响。慢性丙型肝炎和酒精性肝病患者的丙型肝炎可以治愈——理论上对预后有积极影响并减少肝移植需求。目前的抗病毒治疗在超过90%的病例中实现了病毒学治愈或持续病毒学应答（SVR）。抗病毒治疗非常有效，以至于大多数肝移植候选者或接受者在移植前或移植后都可以治愈丙型肝炎。然而，尽管抗病毒治疗成功，但由于持续饮酒的影响，肝病可能在实现SVR后仍会进展。
丙型肝炎合并酒精使用患者的抗病毒治疗应改善移植前后的预后，但医疗人员必须坚决限制酒精使用，以避免丙型肝炎治愈后肝病进展。
酗酒和慢性丙型肝炎病毒（HCV）通常并存，在肝病治疗中都需要加以解决。随着新疗法使丙型肝炎治愈率提高，需要关注持续的酗酒模式，这可能对肝移植前后的肝脏健康产生决定性影响。
