Any reason for this ?

http://www.webmd.com/content/article/4/1680_51403

"People who abuse alcohol are seven times more likely to carry the hepatitis C virus (HCV) than people who drink moderately or not at all. Though the reason for this is unknown, an estimated 10 percent of problem drinkers are infected with HCV, compared to 1.4 percent of the general population."


This seems very strange correlation. Why is being an alcoholic give you more of a chance of being HepC positive?

[copyman]

my guess would be that if you have the hep c virus in your body drinking alcohol weakens the liver and it becomes more prone to damage and helps the disease progress.

[landfill]

It's been known for a long time but I haven't seen an explanation for it and it doesn't get much attention.  When I was diagnosed in 1990 with "non-A non-B", as it was called then, the gastroenterologist I talked to said that the unexplained prevalence among alcoholics  made the medical community suspect another mode of transmission than blood borne.

I'm alcoholic but I stopped drinking in 1969, 3 years before I was infected by a treansfusion.

[52TELE]

I think its from sharing a glass with other problem drinkers , or
possibly not wearing a condom while drinking.

[FlGuy]

I'll slide my feet over thin ice here.  From experience in my misspent youth we would do just about anything to get high, drinking and othere wise.  Drugs of choice, availability and costs deteremined the recreation of the weekends. As a result, many I know (and me)came down with hcv and some went on to long careers in alchol after the drug life became passe'.  Also, I would guess that in those cases in which peoples' immune system are able to battle the virus upon infection are less likely to do so if there is also heavey alcohol involvement at the same time.  Just guesses, but seems logical to me.

[bobbyullc]

most of us junkies from the 60's who did not die from the heroin gave up and replaced it with alcohol. i ended up in aa 10 years after stoping junk...bobby

[Kalio1]

My doctor's explaination of the issue: alcoholics are at a much higher risk for other self destructive behaviors, like shooting drugs. Or they shoot drugs AND drink to excess or as Bobby suggests, used to shoot drugs but turned to alcohol when they gave that up.

[mycoldfeet]

I think Kalio is right, people who abuse alcohol have addictive personalities, and if taken in context (people who abuse alcohol) are 7 times more likely. I would say thats not out of line.

[DoubleDose]

Another, more radical line of thinking is this:  Maybe HCV is carried in a dormant form in the body by many people, even a large portion of the population. This would be non-blood borne virus, residing in tissues such as salivary, sexual organs, mucous membranes, etc.  This form of the virus might remain in-check within the body, and in sort of a 'dormant' form similar to what happens apparently after SVR, when the virus is 'gone' from the blood and liver, but can still be found in various tissues and organs years later by super-sensitive PCR testing.
(known as residual HCV after SVR).

This theory would then suppose that any great shock to the immune system (heavy steady drinking, immune system suppression, etc.) might cause this latent virus to overcome the immune system barriers, and turn into a full blown infection in the blood, and liver.  I have often suspected that this might be the case for many people, especially those that have absolutely no risk factors for HCV, and there are many of these people out there.  In this dormant, 'carrier' population only a very small percentage would ever convert to the full blown virus, and alcoholics would be a very obvious sub-group with the propensity to develop the full blown infection.  

Until someone can explain why so many alcoholics have HCV (and I am sure they were not ALL drug injectors!!!), then I will continue to explore this theory.  I started thinking along these lines years ago, after reading so many suspect accounts of alcoholics and HCV, without any standard risk factors.  To further support this theory and the mechanism for action, look at the people who have SVR'ed and the few that have 'relapsed' with the virus many years after SVR are usually those that had severe immunosuppression take place.  

I am beginning to believe that many people out there harbor a form of the virus,... its just not the standard full blown blood borne infection that we are familiar with.  The virus might be able to pass from tissue to tissue without becoming a full blown infection...but all the same, remaining in the persons who it is passed to, in a chronic, dormant form.

The virus might also do certain sorts of damage if it were confined only to tissues (salivary, sexual, mucous, gastric) such as dry eye, allergy, sinus issues, gastric issues, sexual irritation, etc.  I really believe there is more than meets the eye with this virus.  Time will tell.

DoubleDose

[jmjm530]

I probably should add -- and DD would be the first to agree -- that DD's  proposed theory is highly speculative. That said, here's some speculation of my own :)

(1) The study refers to *antibodies*, not the virus itself, so I think that somewhat dispels the "sleeper" theory.

(2) The screening process used seems based on raised liver enzymes which would be more apparent in the alcoholic population. This could skew results as those with raised liver enzymes would be more likely to be tested for Hep C than those without.

(2) The possiblity of a higher prevelance of prior IV drug use in the alcoholic population (perhaps not acknowledged in a questionaire) could be a major factor.

(3) Other socioeconomic factors in the alcoholic population such as incarceration, non-regulated tatoo parlours, etc.

[doglover28]

The IRB registry for the study is 5034-05-8R2
It's a study done on Blood, urine, cells and liver tissue. Dr. John McHutchinson and his colleagues in the Duke Liver Center are conducting it.  The review board's number is [phone] pr 684-8111.  The trial coordinator is Diane Uzarski [phone].

[DoubleDose]

Also, the reason that this 'dormant, tissue focused form of virus is not detected on HCV blood testing might be exactly that it is not in the blood.  If it is confined locally, within tissues only, then the only way to detect it might be to do an antibody test on the tissues themselves....and a PCR on the tissues, just like they are now doing with long term SVR...and finding replicating virus in those tissues, I might add!

Several years ago tests were done with a large group of HCV positive individuals, and their families.  Guess what:  they found little or no HCV infection on blood testing, within the family members.....BUT...they did find HCV-specific cellular immune reactions in almost ALL the family members, upon testing various tissues and organs by biopsy.  Now if that didn't set off some alarms in the medical community....I do not know what will!!!!!!  That also very much supports my theory of a dormant, tissue-related HCV infection in the greater population that is probably readily passed along through close or intimate contact.

DD

[GrandOak]

Keep in mind that's it's not simply injecting drug usage, but also snorting use when straws are shared because drug use can aggravate nasal vessels, resulting in bleeding and hence blood exchanges.

[NYgirl]

I think Kalio is right, people who abuse alcohol have addictive personalities,"


Heck that's right.........if it ain't cocaine - it's heroin - it's alcohol and finally...twinkies and ice cream.

But...I still have the addictive personality that's for sure.

(All of the above are right - lack of perception while drinking causes POOR life choices etc.)

Plus - someone who drinks a LOT might think more about their liver than a healthy regular person would so they might find out

[mikesimon]

I really don't know how to weigh in on your question. It's a complex issue and I am reluctant to say anything that might be too discouraging. I think I'll leave it with: My opinion is that SVR is durable for the vast majority of patients and it confers the benefits of cure - it stops further liver damage and eliminates the risk of hepatic cancer that HCV carries with it. I hope you aren't offended that my answer is not as responsive as it could be. Mike

[DoubleDose]

I am very interested in hearing more about the study by Dr. McHutchinson.  Do you have any more details???  Also, do you have contact information for him.  If you have an e-mail address that would be great!  This line of study needs to be done now!  I really believe there are atypical infections with HCV occurring in the greater population, that have gone undetected by standard blood testing.  I would really love to have a clearer idea of the test parameters he is setting up, and what his suspiscions are?  His rationale for doing the study, etc.

Thanks for any info you can provide.

DoubleDose

[DoubleDose]

Hey, I truly understand where you are coming from with your answer, and I also believe that SVR is durable, in that it does not result in relapse in the vast majority of SVR's, and maybe occurs only in a small handful, if at all.

But what I am describing might be the equivalent of an SVR state for those who have picked up the virus in tissue to tissue contact from HCV infected individuals.  In other words, they develop a 'residual viral' infection in the tissues, that also does not turn into a true HCV blood borne infection, except maybe under extreme circumstances...like immune system dysfunction, severe alcoholism, and the immune system meltdown that accompanies it, etc.

I think there may be another form of transmission taking place, especially among close, and sexual contacts, that may establish a sort of 'dormant' organ or tissue infection with HCV, with unknown consequences, and unknown capability.

I am fully aware that this is 'off the wall' theory, BUT if guys like McHutchinson is studying the issue, then I may not be too radical in my thinking after all!

I am getting to the point where I am willing to bet that it DOES exist, more so than that it does not exist.  I have a number of supporting observations that cause me to believe this is the case, as well as the alcoholism studies, and intra-familial transmission studies looking at cellular immune responses, etc.

Eventually we will see whether this is a possibility.  If it turns out to be the case, then I would imagine it would be out there in a significent segment of the population by now.

DD

[doglover_forgot password]

Hi,
Duke is doing a study on what you mentioned that HCV can be famaliar and lay dormant.  It's just a study. My doctor, Dr. Mchutchinson is heading it up.
anything is possible.  There are not telling how many virus are out there that the Medical community doesn't even know about. That's why I finally decided to stop worrying about everything and just enjoy each day.

[doglover28]

I forgot to mention in the study that with the permission of the particpant, they will contact family, brothers, sisters, parents etc..to get saliva, urine, blood samples/

[mauilady]

I have to agree with kalio and nygirl about the addictive personality thing... it's all about feeling good, and what we wouldn't do to get that feeling.  And alcohol REALLY contributes to poor/lack of judgement.

The hepatologist at yesterday's class couldn't stress enough the fact that alcohol (for us HCV's) is BAD, BAD, BAD!  No, none, no way, not ever.  Not even O'Douls...