Ethanol has been suggested to elevate HCV titer in patients and to increase HCV RNA in replicon cells, suggesting that HCV replication is increased in the presence and absence of the complete viral replication cycle, but the mechanisms remain unclear. In this study, we use Huh7 human hepatoma cells that naturally express comparable levels of CYP2E1 as human liver to demonstrate that ethanol, at subtoxic and physiologically relevant concentrations, enhances complete HCV replication. The viral RNA genome replication is affected for both genotypes 2a and 1b. Acetaldehyde, a major product of ethanol metabolism, likewise enhances HCV replication at physiological concentrations. Ethanol consumption is a well-known risk factor for chronic liver diseases. Ethanol is also a key cofactor in the pathogenesis induced by hepatitis C virus (HCV), 2 and it decreases the efficacy of anti-HCV treatments (1, 2). Likewise, HCV infection exacerbates liver damage caused by prolonged alcohol abuse (2). It has also been reported that patients with a history of alcohol abuse are more likely to be infected with HCV than the rest of the population (1). In addition, ethanol has been suggested to exacerbate HCVinduced liver diseases in part by affecting the viral titer (2-5). Hepatitis C patients who drink alcohol typically show a pattern of hepatic injury that is more characteristic of chronic viral hepatitis than alcohol-induced injury, suggesting that alcohol enhances the pathogenic effects of HCV rather than exerting its independent effects on liver (6). Several clinical studies have correlated increased serum and intrahepatic HCV titer with the amount of alcohol consumed (2, 4, 5). Abstinence or moderation of alcohol consumption could reduce the HCV titer in some patients (2, 5). Furthermore, in vitro studies suggest that ethanol increases HCV RNA levels in Huh7 human hepatoma replicon cell lines that continuously support the HCV RNA replication without virus production (3,7,8). These studies suggest that ethanol enhances HCV replication both in the presence and absence of the complete viral replication cycle. HCV replicon systems and more recent virus-producing cell culture models have increased our understanding of HCV and provide us with tools for studying potential interactions between HCV and pathological cofactors, such as ethanol (9).Nevertheless, whether ethanol directly enhances HCV production in the context of the complete viral replication cycle has not been demonstrated. Furthermore, the mechanism by which ethanol modulates HCV RNA replication remains controversial as reactive oxygen species (ROS) and lipid peroxidation products, which can be generated during ethanol metabolism, can suppress, rather than increase, HCV RNA replication in cells, suggesting the involvement of other metabolites of ethanol (10 -14). Oxidative hepatic ethanol metabolism is a multistep process (4). Alcohol dehydrogenase, the predominant ethanol-metabolizing enzyme, is found in the cytosol and produces acetaldehyde and NADH. Ethanol-inducible cyto...