Spotlight Series on Hepatitis C

Guide to Hepatitis C for People Living With HIV

Testing, Coinfection, Treatment and Support

August 2007

Living With HCV/HIV Coinfection

Probably the most important aspect of dealing with any medical condition is having time and support to become better informed about choices that affect your health.

Many people who are diagnosed with a chronic disease take the opportunity to examine their lives in order to reduce stress and improve both their quality of life and their general health.

Some of the lifestyle changes discussed below can reduce the risk for HCV progression -- especially cutting down on or avoiding alcohol. Stopping smoking; eating better; resting properly; exercising; and other forms of stress reduction are important for everyone's health.


Alcohol and HCV

Heavy drinking is known to be harmful to the liver. Alcohol intake in amounts of more than 50 grams per day (four or five glasses of wine, beer, or mixed drinks) for men and more than 30 grams per day (two or three glasses of wine, beer, or mixed drinks) for women accelerates HCV progression.

Alcohol harms the liver by increasing both inflammation and scarring. Generally, the less you drink, the better for your liver, since no one has determined what amount of alcohol is not harmful to people with chronic HCV. In some cases, drinking less -- or not at all -- may be more important than treating HCV.

Alcohol increases hepatitis C viral load, which makes HCV treatment less effective. This may be why studies of treatment with an older form of interferon reported that HCV treatment was not very effective for people who drink alcohol. A few newer studies have not reported a significant difference in HCV treatment outcomes among drinkers versus non-drinkers. Nonetheless, some doctors refuse to provide HCV treatment to people who consume alcohol.

Tips for Reducing or Avoiding Alcohol Intake

The following suggestions may help, whether you decide to drink less or quit drinking altogether.

If you decide to stop completely:

  • Don't keep any alcohol at home.
  • Avoid people, places, or circumstances that trigger alcohol use, or develop a plan so that you are prepared and able to deal with the situation without alcohol.
  • Remind yourself regularly about why you are giving up alcohol and the benefits it will bring.
  • Try to keep your mind off alcohol by involving yourself in other things, particularly at times when you usually have a drink.

If you decide to cut down:

  • Monitor how much alcohol you drink. Be honest, even if the total seems unreasonable. Once you know where you are starting from it will be easier to measure or monitor improvements.
  • If you are drinking alcohol, drink slowly and drink plenty of water or juice as well.
  • Drink alcohol with or after food as this slows down the absorption rate.
  • It is better to spread your alcohol intake over the whole week, rather than drinking heavily in one session.

Alcohol and Liver Damage

Alcohol is mainly broken down by the liver, and this process creates byproducts that damage the liver more than the alcohol itself does. Prolonged inflammation from long-term alcohol use causes an overproduction of molecules called free radicals that can destroy healthy liver tissue, subsequently impairing liver function.

Alcohol can also disrupt the production of antioxidants, which defend the body against free radical damage. The combination of overproduction of free radicals and loss of antioxidants can contribute to liver damage.

Women may be more prone than men to the damaging effects of alcohol.

Drinking less -- or not at all -- can be very difficult. Some people cut down or quit on their own, while others find that support groups, counseling, or pharmacotherapy work best for them. A list of resources is provided in this guide.

Recreational Drug Use

The liver is the organ that processes most recreational drugs. These are likely to contain impurities and unspecified ingredients. If you are injecting drugs, use new, sterile equipment -- syringe, cooker, filter, water, tie, and measuring syringe -- each time to protect yourself from reinfection with hepatitis C and from other infections.

If you want to stop using recreational drugs, there are places where you can get help.


Smoking has a negative impact on everyone's health. For people with hepatitis C, there is some weak evidence suggesting that smoking may accelerate hepatitis C progression, but most people in the studies also drank alcohol, making it hard to tell how much smoking mattered.

Stopping smoking is not easy. Quitting during hepatitis C treatment may not be the best time for some people. Giving up cigarettes may be a long-term goal for many people; it may not always be a person's most important short-term priority.

If you feel ready to stop smoking, talk with your doctor about ways to make quitting easier.


A healthy and balanced diet is important for general good health.

Liver abnormalities are more common in people who are overweight. These may include liver steatosis and inflammation. Liver problems are also more common among people with diabetes, and being overweight is a risk factor for developing diabetes.

Being overweight decreases the chance of being cured by HCV treatment.

When overweight people lose weight, their liver condition is likely to improve.

All foods and fluids pass through the liver to be broken down. Avoiding things that are hard for the liver to break down supports liver health.

The most appropriate diet for you depends on a number of factors including age, weight, extent of liver damage, and current symptoms. With advanced liver disease, avoiding or reducing the amount of certain foods may be important. These may include:

  • Fried foods;
  • Foods with a high fat content, especially if they contain saturated or hydrogenated fats;
  • Very high-protein diets;
  • Foods with high iron content, and iron supplements, unless your liver specialist recommends these;
  • Processed food and "junk" food;
  • Caffeine in coffee, tea, and some carbonated drinks;
  • Salt, especially with advanced liver disease;
  • Foods containing additives and pesticides;
  • Sugar, since diabetes is more common among people with chronic hepatitis C; eat less food containing processed sugar and switch from white bread and pasta to whole wheat bread and pasta.

If you find it hard to lose weight or want more information on a healthier diet, ask your doctor about seeing a nutritionist.

Herbal Medicine

Herbal remedies have been used for centuries to treat liver disease, but they cannot cure hepatitis C. So far, no clinical trials have demonstrated that herbal remedies are safe and effective against hepatitis C. Many people use these nonetheless: some because conventional treatment has not worked for them, others because of concerns about the side effects of HCV therapy. Keep in mind that even natural or herbal products may cause stress to the liver.

Milk thistle (silymarin) is often used to treat hepatitis C, although clinical trials have not found any benefit in people with hepatitis C. Research on milk thistle and HCV is ongoing.

Licorice root (glycyrrhizin) has been used to treat HCV, although it has no effect on hepatitis C viral load. Some studies have shown that it can lower liver enzyme levels and may decrease the risk of liver cancer; however, long-term use can cause side effects such as high blood pressure and fluid retention, which are especially serious for people with cirrhosis.

Many other combinations of herbs are being sold to treat HCV or benefit the liver. Unfortunately, these products are unregulated, and they differ in purity and strength. Some may actually be harmful to the liver, and others may interact with HIV drugs and other medications. It is important to discuss the use of any herbs or supplements with your doctor.

This article was provided by Treatment Action Group. It is a part of the publication Guide to Hepatitis C for People Living With HIV.


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