Hepatitis Australia

Alcohol

There is a higher risk of developing liver disease, including cirrhosis, if you have hepatitis C and drink alcohol. Alcohol is also likely to affect your response to treatment, making treatment less effective.

If you have chronic hepatitis C, but not cirrhosis, limit your alcohol intake to no more than seven standard drinks per week and have one or two alcohol free days per week. If you have cirrhosis, it is recommended that you do not drink any alcohol.

To reduce your alcohol intake:

• set a limit, such as one standard drink per day;
• switch to low alcoholic or alcohol-free drinks;
• avoid situations where there is pressure to drink, such as drinking in rounds;
• mix beer or stout with lemonade;
• mix wine with mineral water;
• alternate a non-alcoholic drink with an alcoholic one; and
• aim to have one or two alcohol-free days each week.

Contact your GP or your local community health centre for a referral if you need help in reducing the amount of alcohol you drink. Avoiding substances that are harmful to the liver, such as alcohol, is strongly advised.

For some people, changing their drinking habits can be challenging at first. Taking small steps to reduce the amount of alcohol consumed can help the body deal better with the virus.

Should I cut down on alcohol?

There is no evidence to suggest that total abstinence from alcohol is necessary when you have hepatitis C, unless you have cirrhosis. However, it is recommended that people with hepatitis C who consume alcohol in large quantities should reduce the amount they drink, as alcohol does increase the rate of liver damage.

It is important to avoid alcohol when you are taking prescription medications or other non-prescription drugs. The combination of drugs can be unpredictable and may cause further liver damage.

Contact an alcohol information and support service if you’re having difficulty reducing the amount you drink.

A standard drink is equal to one can of light beer, one nip of spirits, or a 100ml glass of wine.

Smoking

Smoking causes many health problems including heart disease, strokes and cancer. Smoking may also lead to a worsening of gum conditions and dry mouth associated with hepatitis C. There is some evidence that suggests higher rates of particular cancer types among smokers if they are also hepatitis C positive.

Smoking marijuana on a daily basis has also been significantly associated with the progression of fibrosis in people with hepatitis C.¹

Should I stop smoking?

If you have hepatitis C, try to give up smoking because research shows that it can increase the progression of liver disease. Smoking also increases the risk of heart disease, and women who smoke experience menopause on average five years earlier than women who don’t.

People with hepatitis C are advised to reduce or abstain from regular marijuana use. If you smoke, try to cut down or give up completely. You will feel the benefits of quitting straight away as your body repairs itself.

Depending on the number of cigarettes you smoke, typical benefits of stopping are:

• after 12 hours almost all of the nicotine is out of your system;
• after 24 hours the level of carbon monoxide in your blood has dropped dramatically. You now have more oxygen in your bloodstream;
• after five days most nicotine by-products have gone;
• within days your sense of taste and smell improves;
• within a month your blood pressure returns to its normal level and your immune system begins to show signs of recovery;
• within two months your lungs will no longer be producing extra phlegm caused by smoking; after 12 months your increased risk of dying from heart disease is half that of a continuing smoker;
• stopping smoking reduces the incidence and progression of lung disease including chronic bronchitis and emphysema;
• after 10 years of stopping your risk of lung cancer is less than half that of a continuing smoker and continues to decline (provided the disease is not already present); and
• after 15 years your risk of heart attack and stroke is almost the same as that of a person who has never smoked.

Stopping smoking has major and immediate health benefits for men and women of all ages.

Quitting smoking can be difficult. Prepare yourself and plan strategies to cope with the physical or psychological symptoms that you might experience.

For many people it takes more than one attempt to quit—don’t give up trying just because you lapse and have a cigarette. The National QUIT line on 131 848 can help you plan a quit attempt and support you while you give up. Talk to your GP or pharmacist about other treatments that can help you to stop smoking (such as nicotine replacement therapy).

Other Drugs

Illicit drug use

All drugs have the potential to put stress on your liver and can bring on a range of health problems. Injecting unsafely increases your chance of developing infections such as chronic gingivitis, bacterial endocarditis (an infection of the heart valves), blood-borne viruses and skin infections. If you inject drugs and share equipment, you risk being infected with another genotype (strain) of hepatitis C in addition to your existing infection, or becoming re-infected with hepatitis C if you have cleared the virus.

If you inject drugs, use new injecting equipment each time and avoid sharing needles, syringes, swabs, filters, spoons, water, utensils and tourniquets.
You can get sterile needles and syringes from needle and syringe programs and many pharmacies. Information about these programs can be obtained from Hepatitis C Councils or peer-based user groups in your State or Territory.

What happens to my liver if I inject drugs?

One of the roles of the liver is to break down drugs. All illicit and recreational drugs affect your liver because you are never certain of what you are taking, or what has been added to the drug.

Even without hepatitis C, it is difficult to know what these drugs do to your body. In the presence of hepatitis C, any illicit and recreational drug can cause liver problems. Heroin and morphine are not in themselves toxic to the liver, but the substances that they are mixed with can be.

It has been suggested that amphetamines (or speed) can damage the liver, while cocaine and ecstasy have been known to cause liver toxicity and liver failure. Hallucinogenic mushrooms also contain many chemicals that the liver cannot tolerate.

If you inject drugs there are some commonsense strategies to reduce harm. These include cutting down the amount of drug used or the number of times you use, having a break from drug use, getting enough sleep, and eating healthy foods on a regular basis.

What about snorting drugs?

Even snorting can transmit hepatitis C in some circumstances, through nosebleeds and sharing contaminated equipment. If you are snorting drugs with a group of people, use your own snorting equipment (such as a straw or bank note) and keep that equipment to yourself.

Where can I get more information on the effects of drugs on my liver?

There is a lot of information available on alcohol, illicit and recreational drugs. Some people like to have a thorough understanding of how their preferred drugs can affect their health. For more information, contact your local needle and syringe program, peer-based drug user group, Hepatitis Council or drug and alcohol service.

References

¹Hezode, C., Roudot-Thoraval, F., Nguyen, S. et al. (2005). ‘Daily cannabis smoking as a risk factor for progression of fibrosis in chronic hepatitis C’.Hepatology; 42(1): 63–71.