POST treatment alcohol facts?

Does anyone have reference to any studies done on POST treatment alcohol consumption or know anyone who consumed alcohol POST treatment who had only stage 1 slight liver damage? I'm NOT refering to someone with active Hep C or major liver damage. I'm also aware that too much alcohol is not a good thing. I know what opinions people have, I'm looking for facts or personal experiences. Once TX is over either the HCV is gone (cured) or it's not, is that not correct? If any of the virus is left hidden to cause a relapse is there any evidence of alcohol being the cause of the relapse or just cause it faster? Thanks in advance.

[mikesimon]

No, alcohol does not trigger or hasten HCV relapse once a patient is SVR.
Regarding alcohol consumption after SVR: There are different schools of thought. Of course, liver condition should be a major factor to consider because alcohol can impact a healthy liver depending on the amount and frequency of consumption - as you know. Discussions about the advisability of moderate alcohol intake post SVR often get very emotional with strong views on both sides. I'll leave it at that.
Mike

[franke566]

I tried to go back to beer drinking and didn't enjoy it.  Had a couple of Margaritas and the hangover was horrendous.  I choose not to put anymore strain on my liver.  I smoke a little herb thru a water pipe to eliminate a few toxins and that does me just fine.  I don't believe alcohol causes relapse but it certainly affects oru liver-it is poison,
after all but so is sugar and umteen other things.  Moderation is the best advice.

[Willy50]

I'd mention that you wrote post TX and Mikesimon wrote post TX.  That is a huge distinction, or could be for some people.  Other people might only consider alcohol use for instance one year post TX or SVR.

Statistically speaking, after a period of time post TX alcohol probably plays little part in "reactivating" any HCV.

There is a difference in patient liver staging one must factor in.  Drinking practices post TX should be different for a stage zero than for a cirrhotic, no?

Drinking could factor in on how quickly or completely the liver is able to regenerate post TX.

One's staging and drinking seldom exist by themselves.  One could factor in other issues; weight, sex, family history, existing or borderline chromic or extra-hepatic conditions.  I'm not sure that any simple post could provide an adequate blanket answer to the question.

Further, I'm not sure that the data exists yet to tell us as much as we would want to know about liver regeneration, post TX.   Likewise, I think we don't have data on the effects of chronic (or sporatic) inflamation (inflammation) on the livers of SVR HCV patients which alcohol could cause..

best,
Willy

[mj6000]

Thanks everyone. I'm interested in POST TX and also after SVR. I take all responses serious.

[newleaf09]

Never seen any studies, but haven't been looking for them.  I think alcohol use post-TX should be related to known liver damage.  Lots of damage would guide you to very limited or no alcohol use. Just being philosophical here: If there aren't so many healthy cells there to process the alcohol, it would be logical (in my mind) that you'd be putting a strain on them to process the alcohol, possibly leading to unnecessary inflammation.  Less damage, more healthy cells and less strain on that healthy part from alcohol and other toxins.  

Like Frank, I can't really imagine going back to old habits like drinking regularly.  I have become a true 'social drinker'.  The rare glass of wine at a dinner or wedding, but no more visits to the wine aisle in the store, ever.  There has not been enough work done on liver regeneration to make good enough guesses on the state of your liver after SVR.  I don't believe there is a connection between revival of HCV and alcohol.  I see it more as a matter of ability to process the alcohol.  All philosopical, not scientific.

[Joey_M]

I figured I'd write a response here to share my perspective. After I achieved SVR from my first round of tx, my doctor said about a glass of wine (that would be 6 ounces, not the giant size glass) a day wouldn't impact the liver of have any chance of reactivating the virus - I think that falls within moderation.

However, your also are battling diabetes and alcohol could worsen it. Alcohol coverts rapidly to sugar and raises the blood sugar. There are ways to minimize this like always balancing a small amount of alcohol with protein or healthy fats as well as avoiding sugary drinks.

Having invested a full year of your life in this tx and all you have had to go through, why not try and avoid alcohol and to help improve your glucose levels? After my first treatment, I had one ounce of wine and it gave me the worst headache so I mostly have avoided it since - sounds like quite a few here have also had that experience.

Also, you still have several weeks on tx, so best to get through it, get to your SVR and see where your head is at then. The tx drugs really fog up the head and I am really appreciating no drugs in my system now, including alcohol.

[mikesimon]

You said:  "Statistically speaking, after a period of time post TX alcohol probably plays little part in "reactivating" any HCV."

Where did you get that - "probably plays little part in reactivating any HCV"?

I have never seen one expert suggest that possibility or seen one scintilla of evidence that alcohol plays ANY role in reactivation. And "reactivation" itself is questionable. The only suggestion of reactivation I have seen has been in the setting of immune suppressive drugs and that seems rare, to say the least. I am immune suppressed and have been for 9 years - the last 5 while SVR.

Maybe you were trying to be diplomatic or play it safe but the facts suggest that your statement was flat out wrong. Alcohol has NEVER been shown to play ANY role in HCV reactivation.

Mike

[nygirl7]

I'm interested in POST TX and also after SVR. "

If you aren't truly SVR post tx, you aren't.  Alcohol has never been proven to 'reactivate' anything but then again I don't really believe there are studies either way - so nobody could know for CERTAIN.

If you aren't SVR then you are going to be drinking with active virus working to destroy your liver - either way, but you won't know you are SVR until you actually are.

You have to wait till SVR to even contemplate such a thing and at that....it won't be reactivating anything just killing liver cells off left and right.

[mj6000]

After being on treatment so long its like a really bad day at work and you just want to grab a beer. It's been a real mental trip and I know my weakness has more power than my strength right now. You guys are all really helping though.

[Joey_M]

I agree with nygirl that nothing is CERTAIN when it comes to reactivation and alcohol. I don't recall seeing any studies on this and even if there are, studies are not definitive - much of what we "knew" when I did my first tx 6 years ago has evolved (SVR was considered UND after 2 years).

Hep C treatments are fairly recent and the body of knowledge keeps changing.  Always best to error on the side of healthy choices when possible. We all go through so much pain to clear the virus so why risk our health in other ways just because we are SVR?

[mj6000]

Thanks Joey.

[chuckles333]

I know were you're comming from. All through TX I really missed the beer that I drank pre TX. Post TX and even before SVR has been proven, I doubt that alcohol would play any role in the virus returning or not. I know though that after having gone through all that **** for so long to save or improve your liver health, it's sort of counter-productive to do anything that might damage it now. I'm between TX (UND @ EOT) and my 6 months (SVR?) test. I've indulged in a few beer a couple of times and I doubt that that will really bear any consequence to my final TX result. I do know that I just don't enjoy the beer like I used to. I used to have a few beer every other Saturday. Now I might have a few once a month. I thought I'd enjoy it more than I do. Strange....

[mikesimon]

If alcohol reactivated HCV in SVRs we would definitely have heard about it. The durability of SVR status has been extensively studied. I am definitely not advocating drinking when a person is SVR. I am merely stating what I believe to be the facts as they are known today. If anyone has any evidence that alcohol intake has induced a recurrence of HCV in a documented sustained viral responder I would love to see it. I am confident that no one can present any such evidence.
As  transplant recipient who is an SVR and who takes immunosuppressive drugs daily I am very interested in the subject of HCV recurrence. Over the last 8 years I have read every bit of information regarding HCV recurrence I could find and I believe that I would have seen something about alcohol by now - it it existed. I am just interested in the facts. I have no vested interest in being right other than accuracy of information.
Mike

[mj6000]

That's great info Mike!

[nygirl7]

Just to be clear I do not in any way think that you could relapse due to alcohol but I just said I didn't know of any studies so nobody could be 100.00% certain I guess - but it's the most unlikely thing in the whole world.

What I was trying to say is there is a difference between post TX and SVR and if you aren't clear post tx you are going to be drinking and damaging your liver that way.

(Just cause someone just asked me if I said that I thought you could relapse due to alcohol and i realize I probably wasn't very clear).

[Rockerforlife]

Drinking right after finishing TX is not a wise move,i would at least wait until  i had a 6 month SVR.I still deciding if i will have a drink to celebrate if i SVR this Jan.I wll feel kind of quilty because i have over 4 years clean and the 5 year mark looks like a goal worth having.

[Proactive]

"Does anyone have reference to any studies done on POST treatment alcohol consumption"---17 posts so far---you know what they say about opinions.................;^)
here's mine,use your best judgement

[Rockerforlife]

Common sense,if you drink after SVR and you dont feel good,well,this should say something.If you had low damage to start with odds are you can drink "normal" again.if your liveR was hard as a rock before before TX and you SVR....i think drinkn should be the last thing on your mind at least for a while,at least until after the next BX.

[newleaf09]

I can think of a dozen studies I'd like to see, like female hormone levels on TX and loads of post-TX studies, but I think it will be a really long time before any scientist or funder cares about those things.  All research roads seem to point to shorter TX and non-interferon TX.  Those are good goals but doesn't clarify all the goofy problems that pop up after the major goal, SVR, has been reached.

[Willy50]

On a quick lunch

First Mike, it may have been apparent what I meant;

mj6000 wrote post TX and you wrote post SVR----that is what I *mean* to write.
-------------------------------

No time to elaborate on your query but I agree with what you wrote and I think that I more or less said that. I meant to dismiss the possibility, not allow it was a possibility.

There are numbers of people who an SVR does not prove durable and there are theories as to why.  I don't think good data exists as to why it is though.

I don't know if I can write this clearly enough while in a hurry.... but..... at what point to you think it's safe to drink?  After TX if UND?
OR after SVR?  
IF your answer is after SVR but NOT post TX then would that be due to the grey area where alcohol might impact the durability of the potential SVR?

If I follow your logic (about deactivation theory) it would seem that it suggests that one could drink alcohol as soon as one was UND.  My response, as unclear as it may have been was intending to write about that period between post TX and SVR.  I still didn't think that there was much evidence to suggest "reactivation".

I don't know the answer; I don't know if modern medicine knows yet and it is almost bound to be differing answers for different situations.

Yes, though, I agree; I've not seen any evidence studies or what not of alcohol "reactivating" .......causing to become HCV positive again any SVR'ed patients.

Sorry; this is thrown together quickly.  Gotta go.
I hope that I clarified what I meant; not muddied it further.

Willy

[Marte313]

I started to drink again a couple of weeks post tx after consulting with my dr. I'm a geno 1b, guessing stage 0 since I started tx 6 months after acute stage, and were still und 9 weeks post. My dr said alcohol had no influence on the matter of relapsing or not as soon I had finished the treatment.

[DD9th]

I am holding up in front of myself the thought of being able to celebrate with a drink when I am done with this treatment.  

It helps me to have something to look forward to.  Kind of like a reward for being so good (since last March)

In a way, I hope I don't like drinking, when I do try it again.  

I do feel that since I have been so good, and that I was able to quit on the spot, the day I received the news of abnormal liver function (high alt/ast readings), that I deserve a treat.

I quit just like that, without any complaint, and I am damn proud of myself (I was a daily after-work cocktail hour drinker, since I was 16! (I'm 48 now) and psychologically, I miss it terribly.  

Although right now on tx, I am definitely feeling too tired all the time to really even want to drink.)

I won't be done with the tx until March, and then that will be a full year without a drop of alcohol.    So, if I continue to be UND (und at 4 weeks), and if my ALT/AST continue the direction they are going now, and soon get to be within the normal range, I WILL have my cocktail, maybe not a vodka/tonic (my drink of choice), but instead a glass of really good red wine.  Yea baby!  I can't wait.

[Rockerforlife]

If you dont wait for your 6 month SVR...you are taking risks....what happens if you relapse at the 6 month PCR test?....this means you would have been drinkn on a infected liver bteween the end of your tx and the 6 month mark and more damage will be done...if it was me....id wait for the 6 month,which i am BTW

[DD9th]

It is something to think about, definitely, but I also need something to look forward to.  March is already so far away to me.  I just really need something to look forward to.

[DragonSlayer45]

This virus is not activated or caused by alcohol consumption. If you are SVR that means you no longer have the virus. Drinking alcohol will not bring it back. Having said that Alcohol and HCV both can damage the liver. Depending on how much damage you liver sustained from the virus would be a more logical point to consider if you were to drink again. Moderate or social drinking if you had mild damage should not pose a problem. If you were Stage 3 or 4 that might not be a wise decision. I would not advocate drinking heavy for anyone. In my opinion if you are SVR , have mild damage, and you come home an have a cold beer on occasion or a glass of wine with dinner on occasion you are fine.

[mikesimon]

You said: "There are numbers of people who an SVR does not prove durable and there are theories as to why.  I don't think good data exists as to why it is though."

I have not seen that Willy. What I have seen is evidence of "persistent HCV" or "occult HCV" detected in PMBCs and liver tissue of sustained viral responders. I have not seen "numbers" (if by that you mean a significant number) of late "relapse" in SVRs. I can think of perhaps 10 at the most and they involved the initiation of immunosuppressive drugs. That is an entirely different setting than alcohol use and really suggests some type of ongoing persistent or occult virus post SVR that is not serum detectable but becomes so in a significantly immune suppressed patient. I find this to be an extremely fascinating and complex subject but it is a wholly different discussion.

You asked: "I don't know if I can write this clearly enough while in a hurry.... but..... at what point to you think it's safe to drink?  After TX if UND?
OR after SVR?"  

I didn't say that it was ever "safe to drink" - I thought I made it clear that I did not wish to weigh in on that issue. Alcohol poses it's own set of potential problems regardless of the presence of active HCV.
In terms of HCV only, my opinion is that EOT UND does not mean SVR. Damage from HCV is thought to be accelerated by alcohol intake so, in that setting, I would think that alcohol intake could be injurious in a relapser. Patients who relapse often become serum detectable rapidly so the HCV is replicating and alcohol is never a good thing with active hepatitis c. The alcohol would act the same way it does in any active HCV patient - it would accelerate liver damage.
I do not believe in alcohol induced reactivation in patients who are not relapsers - and I know that takes time to determine SVR. I believe that the studies that have been done on SVRs and Relapsers surely must have questioned patients on their lifestyle post TX and, if alcohol was a factor, a pattern would have emerged that would have suggested that alcohol encourages or triggers relapse. Of course, this is my opinion but it is based on an absolute lack of evidence to the contrary. Relapse has been studied, and is still being studied, so intensely that I find it hard to believe that, if alcohol is a factor in relapse, no one with credibility has yet posited that alcohol influences, triggers, hastens or encourages HCV relapse. If a credible and credentialed expert has even obliquely referenced anything like that well - I have not seen it.

Be well,
Mike

[nygirl7]

While I do understand the concept of occult virus, I honestly can't remember seeing anybody who was truly SVR go back to being a chronically infected person again in all the years I've been here.  Who were they all?

[franke566]

Alcohol plays no role in re-activating Hep-C!  This is true.  It is however corrosive to the liver and does play an active role in lowering the inhibitions in say an addict thereby
increasing the likelyhood of repeating behaviors that caused them to be infected in the 1st place.  Now, don't get your hackles up.  I am merely suggesting that alcohol "could" indirectly lead to re-infection.  My hepatologist told me he sees this time and again.  If I was an addict it probably began with social drinking and escalated to I.V. use.  If I was not an alcoholic or an addict and was infected with
Hep C via tats or blood transfusion or some other route I think a glass of wine or a
beer would be fine, depending on ones liver condition.  But if I were an addict I would avoid anything that might compromise my judgement.

[cherinohair]

I never would have considered myself an alcoholic before tx, but BOY DO I MISS A GLASS OF WINE IN THE EVENING..........OR A COLD BEER OR THREE AFTER CUTTING THE GRASS..........OR A DIRTY MARTINI.............OR A COSMO..............LOL.....I used to think I was a social drinker....no I wonder..and can't wait to finish tx (i'm at 27 weeks) geno 1; so far nondetected; rapid responder WITH LITTLE OR NO SIDE EFFECTS EXCEPT MAJOR HAIR LOSS....guess I shouldn't complain. Good luck to all of you going thru this with me!!!

[nygirl7]

But if I were an addict I would avoid anything that might compromise my judgement. "

What an excellent point.  Definitely what lead to infection in some to begin with....and alcohol definitely does destroy inhibitions oy vey!

[Rockerforlife]

Alcohol is respoNsible for  the 3rd largest leader of deaths in north america.,#1 killer is  Tobacco,# is 2  processed food,... Marijuana???............ZERO

[Proactive]

They must not have shown reefer madness up there in canada.

[R Glass]

"Alcohol is respoNsible for  the 3rd largest leader of deaths in north america.,#1 killer is  Tobacco,# is 2  processed food"

America's Leading Causes of Death
1 Heart Disease  
2 Cancer
3 Stroke
4 Chronic lower respiratory diseases  
5 Accidents (unintentional injuries)  
6 Diabetes  
7 Influenza/Pneumonia  
8 Alzheimer's disease  
9 Nephritis, nephrotic syndrome, and nephrosis
10 Septicemia

[Rockerforlife]

1.Tobacco 435,0001
2.Poor Diet and Physical Inactivity 365,0001
3.Alcohol 85,000 1
4.Microbial Agents 75,0001
5.Toxic Agents 55,0001
6.Motor Vehicle Crashes 26,3471
7.Adverse Reactions to Prescription Drugs 32,0002
8.Suicide 30,6223
9.Incidents Involving Firearms 29,0001
10.Homicide 20,3084
12.All Illicit Drug Use, Direct and Indirect 17,0001, 5
13.Non-Steroidal Anti-Inflammatory Drugs Such As Aspirin 7,6006
15.Marijuana  ZERO



http://drugwarfacts.org/cms/node/30

[WriteItDown]

I wonder how they define a death caused by poor diet and physical inactivity.  I would think that poor diet and physical inactivity would contribute to many of the more direct causes of death; but how do they quantify it in order to actually attribute a death to it?

[FlGuy]

Four out of five dentists who chew gum, chew Trident.

[R Glass]

This came from the site you posted.

"In the United States, chronic HCV infection accounts for 8,000 to 10,000 related deaths annually.

“Non-Steroidal Anti-Inflammatory Drugs Such As Aspirin 7,600”

So I am supposed to believe, almost as many people die from aspirin as they do from HCV?

They must have been stoned.

[Rockerforlife]

"I wonder how they define a death caused by poor diet and physical inactivity"?


1 Heart Disease  
2 Cancer
3 Stroke

"Lead, follow, or get the fcuk out of my way!
Lone Biker

[jphsmhk2]

Stage 1---  grade 1-2.  Svr for 10 years now.  Lab work :  lft and quanatative test every year or two for the last l0 years.  Every thing is fine.  Drinking on the weekends about 6-9 drinks.  Just being honest and wanted to share.  Please don't comment about me.  Thanks Medhelp and ALL  the people who share their stories.  You are a blessing -- thanks again.