He is still drinking

[kimberlynn]

My husband has hep C , geno type 1a, viral load of 1,553,744. alk phos 149 alt 142 and ast 99.  He stopped drinking for 10 days and now he's back to drinking every day.  Not just 1 or 2 beers, he's drinking about 20 every day.  He had an ultasound it did'nt show anything. They would"nt do a biopsy around here we have to go to St. louis U. His platlets are 40,000 thats why they would"nt touch him here. He has'nt started treatment yet cuz they waiting for the biopsy.  If anyone could just give me some advice, I'm very scared and worried.   THANK YOU!!!!!

[jmjm530]

The good news if you want to call it that, is that a newer study suggests alcohol may not impact as much on treatment response as previously thought.
http://www.hivandhepatitis.com/hep_c/news/2006/071406_a.html

The bad news is that heavy alcohol use -- over 5 drinks a day -- can end up destroying your husband's liver by speeding up the advancement of fibrosis which may turn into cirrhosis.

The biopsy is definitely the next step to see how much liver damage your husband has. Unless he needs to treat immediately (significant liver damage) my personal opinion would be to make all efforts to get him to stop drinking alcohol prior to treatment, even if you have to have an intervention of some sort. If he has significant liver damage and cannot stop drinking in spite of all efforts, then he might have to treat if he can find a doctor who will treat him on alcohol, which may be difficult. The other question is what kind of compliance could you expect from someone drinking that much a day?
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I just want to be absolutely clear that neither the study or myself, advocates drinking alcohol on treatment (or off treatment for that matter). My understanding is the reason for the study was to try and help 'hopeless' cases of those affected with the virus who were unable to stop drinking after repeated attemps. In these cases, seems better to treat and drink, then just to drink and not treat.

-- Jim

[mikesimon]

Obviously the advice is for him to stop drinking completely. There isn't much upside in doing anything until he's absolutely sober and off alcohol completely. Someone may have advice that will help with this problem but I am not that familiar with approaches to sobriety. Any discussion of treatment options is premature because with alcohol intake at that level there is no sense in starting any type of treatment. Good luck, Mike

[jmjm530]

The study conclusion for those interested. It is also important to note that compliance was down in the alcohol drinking group, i.e. more drop outs. For that reason SVR rates were only comparable in the drinking subgroup that completed treatment. And again to clarify, no one is suggesting anyone drink on treatment or outside of treatment. But in the real world, there apparently is a sub group of folks who are unable to stop drinking and have HCV. What the study shows is that they should not be excluded from treatment although they will need more help than others in complying with treatment.

--------------------------

"...The researchers concluded that alcohol dependence significantly affects quality of life for individuals with hepatitis C, but does not affect health utility or health value. Further, having a CAGE score that met the criteria for alcohol dependence was not associated with altered medical decision-making.

Together, these studies suggest that heavy alcohol users continue to value good health, and may be able to adhere to -- and respond well to -- hepatitis C treatment. Anand and colleagues recommended that patients with a history of alcohol use should not be excluded from HCV therapy, but instead should receive additional support to ensure their ability to complete treatment.

Nevertheless, it is important that patients with hepatitis C cut down on their alcohol use, especially in light of another study presented at DDW 2006 which showed that long-term heavy alcohol use promotes the development of hepatocellular carcinoma in rats, even in the absence of other risk factors such as chronic viral hepatitis.

[nygirl7]

Drinking alcohol as you well know is poison to the liver plain and simple and leads to cirhosis in some cases.

It doesn't sound like there is much you can do until he realizes he is going to die if he doesn't stop. The liver with HepC can only withstand so much abuse until it develops end stage liver failure. I wish there was something else to say but there just isn't.

As an alcoholic I know how hard it is to stop but he has to.

To do treatment while he is not sober would make no sense because there is evidence that the interferon does not work while alcohol is in the system. So...he would negate anything it might do.

It's so hard for you - hard enough to live with an alcoholic but with the additional worry of the plus of hepc well...I feel bad for you.  I believe YOU should go to alanon or some support group like that so you can be helped to deal with all this.

Put your time into working on making sure YOU are ok because obviously he doesn't have it in him yet.  Many people are weak and can't face what they are doing to themselves so they chose to just ignore it completely. It's sad but it's impossible to force him to face what is going on.

I would think honestly the best bet would be to get him into a center where he stays for at lest 30 days and see if that could help him.

But...treating right now drinking as heavily as he is would just be a waste of time.

I'm so sorry you have to go through this, nobody deserves it at all.

[nygirl7]

By the way liver cancer is a very big fear when it comes to alcohol and hep and having a damaged liver.  Liver cancer is usually fatal I believe. Being in the specific group he is in.............he's at a much greater risk for developing it.

If he thinks a 'few' drinks won't hurt - remind him how much he is increasing his chances at getting cirhossis and liver cancer. They are not just made up things..............ask anyone here who has it or knows someone who has died from it just because they had hepc.

[mikesimon]

I looked at the study and I am not quite sure what it says. It seems to suggest that alcohol use does not correlate with cirrhosis. Kimberly's husband has a platelet count of 40,000 which is a factor often associated with some liver architecture change. Furthermore, if it is true that alcohol use accelerates viral replication as well as liver deterioration, then it would appear to follow that heavy alcohol use would be associated with increased liver damage and that alone would affect response to TX. There is alcoholic cirrhosis so it would seem that  heavy alcohol use with HCV would be more likely to result in fibrosis and/or cirrhosis and therefore influence negatively treatment response. Mike

[jmjm530]

Kimb: I've only been drinking heavy for about 2 years.
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I don't know much about alcholism (alcoholism) or the best way to treat it, but I'd go back to what NYGirl said about how difficult it might be for an alcholic to quit drinking when their partner is a heavy drinker as you categorize yourself. The fact that you've been drinking heavy (only) for about 2 years seems more of an intellectual point and nothing that would help your partner. You might consider talking to your partner about entering a program like AA together, and see this through as a couple, if you're so motivated.

-- Jim

[jmjm530]

I think the part of the study you're referring to is "...Alcohol dependence was not correlated with the presence of cirrhosis or decompensated liver disease..." ----------------
My reading is that they're talking about a correlation within their study group of 60 participants and not a global statement on the relationship between heavy alchol consumption and cirrhosis over certain time periods.

What the study said to me is that there is a sub-group of alcoholics who have Hep C who cannot/will not stop drinking. I think we all will acknowledge that not every alcoholic will stop drinking even with a HCV diagnosis.

What the study says that in this group of Hopeless Alcoholic HCV patients (HAHCV)treatment can benefit them as long as they are able to comply, i.e. take all their doses. And therefore, the HAHCV's should not be excluded from HCV treatment programs.

This makes sense to me as long as all avenue's are explored in trying to get the person to stop drinking. At least this way, you can potentially end up with someone without HCV and a drinking problem as opposed to someone with HCV and a drinking problem. The latter being a real recipe for disaster, not that anyone recommends the former. The study also suggests that the idea that alcohol totally negates the effect of interferon may be wrong. And while no one is suggesting anyone drink during treatment, this fact might be reassuring to someone who "slipped" for a few days, in that they do not have to throw in the towel, just straighten up and keep going.

As to the platelets, etc, the upcoming biopsy should tell the story. If it turns out her husband has cirrhosis, then that brings up other issues that I'm not sure that the study dealt with, although we're just looking at commentary from an abstract.

Hope this finds you well,

-- Jim

[mikesimon]

I couldn't be certain if they were referring to recent alcohol users or current alcohol users. Mike

[jmjm530]

Mike: I couldn't be certain if they were referring to recent alcohol users or current alcohol users.
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Good point and I'm glad you picked this up. I've re-read the article a few times and like yourself, cannot be certain anymore. The first quote below seems to suggest that they are still using alcohol on treatment while the second quote talks about 'past and recent". Wish they would clarify these things more in the abstracts and hopefully they do clarify in the full-text, or maybe they didn't collect during treatment data on drinking versus non-drinking although you would think they would.

Certainly, the best choice would be for anyone who drinks alchohol to refrain completely before treating. As to whether alcohol WHILE ON TREATMENT affects SVR, it is impossible for me to tell based on the study although those interested could either order up the full-text and/or contact the study authors.

-- Jim



"....Together, these studies suggest that heavy alcohol users continue to value good health, and may be able to adhere to -- and respond well to -- hepatitis C treatment..."

"...The authors concluded that eligibility for hepatitis C treatment was reduced in past and recent drinkers, and that recent alcohol use was associated with increased treatment discontinuation and lower likelihood of achieving SVR. However, patients who used alcohol and completed treatment had a sustained response rate comparable to that of nondrinkers..."

[mauilady]

My feeling on all this (based on my personal experience) is that if one REALLY likes throwing gasoline on the fire, sure, go ahead and drink... it's your life.

What stopped me in my tracks was the thought "If I drink, I'll die".

[miked]

Does he have kids?  Maybe they can reach him.

[GrandmaA]

My GI told me with liver cancer you can go really fast.

[kimberlynn]

He has 1 son, 17 years old. I tried that, his son does'nt realize how serious this is. I'm sure that I may have some liver damage, but I tested neg. for hep c and my enzymes were normal. It's hard to stop drinking, very hard.  I work as a bartender!!!   I've only been drinking heavy for about 2 years. My husband has been drinking heavy for 20 years off and on.  He got hep c from iv drugs.  He stopped all that before I even met him. He went to prison over it. That was about 7 years ago. They tested him in prison and he was neg then. He said he only used once since his release from prison. I said that must be when you were infected. The funny part is my husband does'nt look sick, or act sick, he works 12 hours a day.  He then comes home helps with the housework etc. His skin and eyes are'nt yellow, no symptoms at all. WIERD.   We've only been together for 2 years an d will be married 1 year next month.  He's 43 and I'm 38. Just found out about the hep c in nov. He took aspirin and had black stools. Now I know it was cuz of his low platlets.  Tested neg. for other dieases caused by iv drug use. Thank God for that.  Thanks again everyone!!!

[ASmile4U]

Dr. Bruce Bacon at St. Louis U is participating in a Fibroscan trial right now.  Might be worth looking into since his platelets are so low.  
It takes about 3 months to get in.

[rosebud57]

oh i read your question, jmjms reply and slid down to the bottom.  despite the idea that it may be better to tx. despite txmt and that someone may still benefit.  I know how much water we have to drink and the alcohol and even coffee and or soda counteracts the hydration of water..  just that alone would be hard.  these meds are strong.

is there no stopping through an alcohol tx program.  inpatient might be helpful if he needs more support, followed by intense outpatient, and AA. and you could/should also attend a support group even if he won't. but anything he would do could likely help (outpatient)  it really would be best to address the drinking problem.  a good tx program would use motivational interviewing technique to help client see the need to change on his own.. always works better if they make decisions on their own.  no one likes to be told what to do. nor will they be motivated to do so.. hence name "motivational interviewing"  that is just the beginning, once a person agrees that they need to change a behavior - than tx plan is developed another method is used (education, cognitive behavioral, support groups, maybe antidepressants, etc)

good luck.
rose