Alcoholic liver disease and the hepatitis C virus: an overview and a point of view.

Alcoholic liver disease (ALD) and the hepatitis C virus (HCV) are two common diseases in the western world. 30-40% of patients with ALD suffer from HCV and 70% of HCV patients are heavy drinkers. The association between the two diseases accelerates the chain of events that leads to liver cirrhosis and hepatocellular carcinoma (HCC). The reason for this is that the two diseases have a synergistic effect on oxidative stress, the immune component, and the mechanisms of carcinogenesis. The relative risk of liver cirrhosis and HCC has increased very significantly. A clinical condition of particular seriousness is represented by acute-on-chronic liver failure (ACLF) characterized by the recurrent superposition of an episode of severe acute alcoholic hepatitis (AAH) on a framework of advanced HCV-related chronic liver disease. Currently the possible failure to respond to medical therapy involves liver transplantation in selected patients. Antiviral therapy with PEG-IFN and Ribavirin enables similar results in a group of patients without ALD. The need to eradicate the infection represents a significant motivational reason for the abstention. Ultrasonographic surveillance should take place every six months and should be continued following possible viral eradication. Other associated diseases, but also the potential oncology of ethanol even after a long period of abstention may be the cause of HCC. This attitude will be followed by the introduction of new antiviral drugs.