drinking

[alice cole]

have you been told you are allowed to drink after treatment ?

[drofi]

Independent from the discussions, but I didn't want to start a new thread, since AUDIT is a little bit off topic.

Do you or your loved ones have a problem with alcohol?

The Alcohol Use Disorders Identification Test:
http://tinyurl.com/25p58y

[Forseegood]

I'm not trying to point fingers here, and ultimately, what you do is your own business. Youre the only one who knows your situation anyway, I'm just going by what you wrote in some posts on a hepatitis board.

But "alcoholism" is a very general word, with many applications. You could use other people's experiences to define it, if you'd like. There are prob many grades and stages, if you wanted to assign grades and stages. A good definition maybe, is if alcohol is interfering in your life. If you have a problem with labels and alcoholic, reminds you of some bum living in a dumpster...Say, a "problem" drinker if you'd like, for your own purposes, rather then "an alcoholic".

My mother has been enjoying "one" glass of wine with dinner for ages. My younger sister moved-in with her 4 years ago now (who is a much easier to categorize, falling down drunk "alcoholic" , though she'd have you thinking it's really not that much the alcohol, but it's the dope that's her problem. She almost died right before she moved into my parent's house from advanced alcoholic cirrhosis, her liver and kidneys failed and she was in the ICU for 4 months, she's considered a medical miracle that she didn't die, that situation was  the only think that's scared her sober, nothing else did. She does not have hepatitis, if she did, she'd of been dead many years ago with her previous lifestyle.)

Anyway, I think my mother is a perfect example of someone who drinks wine regularly (one glass a day), but is not an alcoholic, not by any definition.

When she stopped drinking (in order to not have any booze in the house because of my sister) she merely thought it *annoying*, but it wasn't any big problem for her to stop.

She thinks it a "treat" that when my sister is away on vacation or something, that she can resume her one glass of wine at dinner. The fact that she can't drink her glass of wine at dinner isn't particularly troubling to her at all, she hardly ever mentions it. It doesn't really occur to her that much, in other words, *it's no big deal to her* only a little annoying.

You on the other hand, if I remembered correctly, have said you've been diagnosed with hepatitis, AND fatty liver (alcohol is a real no no with fatty liver I understand, nothing will cause fat better then alcohol) and yet you insist you have no real problem?, but you'd like some advice on how to maybe "cut down or go cold turkey? or, you don't think you need to go cold turkey?

Your posts are somewhat confusing, at least to me, but I'm easily confused, lol...anyway.... I'd really look at that this issue if I were you. This disease is not playing around, probably a good idea not to play around with it. You got two strikes against your liver, hepatitis and fatty liver, alcohol at all is not a good idea for you, and I think in your heart of hearts you probably know that. If you weren't wrestling with this issue, I doubt if you would of made your posts. Believe it or not, not trying to be "Marion the Librarian" here, dispensing out morals to people, I don't look at this as a moral, or weakness issue, just a health issue. If you truly have some trouble stopping, as you know, there are plenty of programs, etc. to help you in those efforts. Best to you in whatever you decide for yourself.

[honey11]

I agree...if original poster was truly interested in topic,,,,why no response?  Seems to work everytime though lol   I'm just waiting for a thread to start that is asking how much you can drink daily while on tx?  

This drinking issue is just like politics,,religion etc and we all have our own ideas on it so not sure if any of us will ever be able to convince others on their view but its always fun trying!

[lalas0]

OMG like someone stated before why would you take the chance on having to repeat treatment. I t doesnt help the hcv to spread faster but it does do more damage to the liver so why bother with treatment even if your gonna drink. I had a sip of my daughters Strawberry Margarita and been regretting it ever since and that was just a small sip. I couldnt even imagine what a whole drink or two would do to me. I am in such pain now I cry. I cant take pain meds. Cant even take tylenol without complications. So PLEASE dont drink. You are asking for trouble.

[jmjm530]

No doubt some of these threads are started for reasons other than the quest for information. Problem is hard to tell on an individual basis, and regardless sooner or later the thread takes a life of its own, after the first person states their opinion.

Certainly, the drinking issue is one that crosses just about everyone's mind at some point, and no doubt most of us have discussed it with our doctors at some point in the process. Not surprising then that people would post the question from time to time (like the sexual transmission issue) to get more of a perspective.

If MH had a FAQ section, or a better organized archive, then posters could be referred elsewhere so we don't have to start from ground zero each time on such an emotional issue. That said, the alcohol threads have been getting more civil lately -- no name calling, etc. Must say I did get a chuckle out of "Drofi's" original response.

So Space... Where exactly are you in the treatment process these days and how are things going?

-- Jim

[spcecst2]

your right I don't even know why I posted I should really know better after all these years!

[stevenNYer]

On this topic, we all get worked up.  But I notice the original poster on this topic often doesn't even come back to provide a follow-up comment.  Isn't that saying something?  Just an observation.

[shastri20032003]

" why would anyone who successfully achieved the golden svr contemplate drinking? "
because for this group of people alcohol was probably a way of life before treatment...like me.. and they are on the look out for studies that support drinking after achieving SVR...in moderation which never happens unless you were a moderate drinker for a long time before treatment or just a connoisseur like Pigeonca before starting treatment

this is the harsh reality....or else as New york girl simply put it, common sense would tell you that alcohol is not good for the liver,specially if you have/had a liver disease....inspite of the several studies contradicting this
So dont look for studies supporting drinking if you have/had hepc....if you still want to drink,be honest to yourself that that's the choice you are making inspite of it not being a good one for your liver
No more studies are going to convince me that taking alcohol is ok to have in moderation...if I drink again I will drink accepting the fact thats what I want to do inspite of the probability of having negative consequences...even if I drink in moderation

[spcecst2]

“Alcohol can compromise the immune system”

“The present study has failed to show an association between alcohol use and HCV viral titres”. There may be another argument against drinking after achieving svr? If we agree that your own immune system may play an important part in achieving and maintaining svr, especially with all the information coming out about the “OCCULT” (with the jury still being out), and alcohol ""CAN"" compromise your immune system, why would anyone who successfully achieved the golden svr contemplate drinking?

[jmjm530]

I agree with your statements and uderstand your reluctance to get involved, but sometimes its very hard to sit back and see something painted black and white when it's not. Both of my docs told me to go ahead and live my life (in terms of my liver) as if I never had hepatitis C. That doesn't mean to abuse it with alcohol, rx drugs, etc, -- but basically what they were saying is that I'm under no stricter orders because of my PAST hepatitis c status which was somewhere between stage 2 and 3, before treatment, and closer to stage 2 (via Fibroscan) four months post treatment. As to regression of fibrosis after SVR (my firm understanding is that this is common, although not guaranteed), not sure if we agree or not, but happy to discuss more elsewhere.

Be well,

-- Jim

[jmjm530]

There should have been quotes on my second to last post. These were exerpts from a Cleaveland Clinic commentary differentiating heavy alcoholic consumption from light consumption. No one doubts that heavy alcoholic consumption is bad for the liver, not to mention the rest of you.

[jmjm530]

"Alcohol has no effect on hepatitis C virus replication: a meta-analysis"

http://gut.bmj.com/cgi/content/abstract/54/10/1468

[jmjm530]

Overall, very little effect of alcohol intake on degree of fibrosis was identified. Only the highest amounts (more than 50 grams)* of alcohol intake were positively associated with fibrosis.

What does this mean for our patients with HCV? It seems to this reviewer that the stern warnings we have previously given about the possible dire consequences of even modest alcohol intake now must be tempered.

* five standard drinks
http://www.clevelandclinicmeded.com/hcv/litreview1.htm (fifth article down)

[drofi]

http://tinyurl.com/2cblhf
LDL Receptor Levels, Alcohol Consumption, and HCV Viral Load in Hepatitis C Patients
Alcohol consumption has a major impact on the natural history of chronic hepatitis C virus (HCV) infection, although the underlying mechanisms are still poorly understood.
As reported in the September 2006 Journal of Viral Hepatitis, French researchers conducted a study to evaluate the impact of alcohol use on HCV viral load and expression of low-density lipoprotein receptor (LDLR) and CD81. Past research has shown that HCV uses LDL receptors to enter cells, suggesting that increased receptor expression might facilitate viral replication.
The study included 38 consecutive HCV-infected patients classified into 3 groups:
Group 1 (n = 18) consumed 10 grams (g) of alcohol or less per day;
Group 2 (n = 8) consumed 30 g or less per day;
Group 3 consumed more than 30 g per day.
Receptor expression was measured in peripheral blood mononuclear cells by flow cytometry analysis, and in the liver by real-time polymerase chain reaction (RT-PCR).
Results
Serum HCV RNA and total HCV core antigen levels were significantly correlated.
Levels of both HCV RNA and core antigen were higher in Group 3 compared with Group 1, but the difference was not statistically significant.
In peripheral blood cells, alcohol consumption had no effect on expression of proposed HCV receptors except for CD81, which was up-regulated on monocytes in Group 2 patients.
In the liver, HCV viral load and levels of LDLR transcripts were significantly higher in Group 3 compared with Group 1.
Remarkably, according to the authors, a significant positive correlation was found between LDLR transcripts and HCV RNA levels (RR = 0.83; P < 0.0001).
In vitro experiments suggested that the effect of alcohol on LDLR expression was indirectly mediated by both tumor necrosis factor-alpha (TNF-alpha) and interleukin-1beta.
Conclusion
In conclusion, the authors wrote, "this study is the first to support a role for LDLR in the natural infection by HCV in man."9/22/06
Reference
M Carriere, A R Rosenberg, F Conti, and others. Low-density lipoprotein receptor transcripts correlates with liver hepatitis C virus RNA in patients with alcohol consumption. Journal of Viral Hepatitis 13(9): 633-642. September 2006.

http://tinyurl.com/yw7a8k
Alcohol Clin Exp Res. 2006 Apr;30(4):709-19.  
Hepatitis C infection and alcohol use: A dangerous mix for the liver and antiviral immunity.

Szabo G, Aloman C, Polyak SJ, Weinman SA, Wands J, Zakhari S.
Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts 01605, USA. gyongyi.***@****
This article presents the proceedings of a symposium presented at the meeting of the Research Society on Alcoholism, held in Santa Barbara, California, in June 2005. The organizers and chairs were Sam Zakhari and Gyongyi Szabo. The presentations included (1) Mitochondrial Abnormalities Induced by Hepatitis C -Alcohol Interaction by Steven Weinman; (2) Effects of Acute and Chronic Ethanol on Innate Antiviral Signaling Pathways, Hepatitis C Replication, and Human Liver Cell Transcription by Stephen Polyak; (3) Ethanol Alters Dendritic Cell Function In Vivo and Impairs the Subsequent Cellular Immune Responses to Hepatitis C Proteins by Costica Aloman; and (4) Pathogenic Interactions Between Hepatitis C Virus and Alcohol Use in Humans: Dendritic Cells as Common Targets by Gyongyi Szabo. This symposium summarizes the state of knowledge of cellular and molecular pathways by which alcohol and HCV have pathogenic interactions resulting in depression of the immune response and liver damage in chronic HCV infection.
PMID: 16573590 [PubMed - indexed for MEDLINE]

[drofi]

http://tinyurl.com/yvbn66
http://tinyurl.com/2884db
Alcohol Increases Hepatitis C Virus in Human Cells
Drinking May Compromise Treatment Success
A team of NIH-supported researchers today report that alcohol increases replication of the hepatitis C virus (HCV) in human cells and, by so doing, may contribute to the rapid course of HCV infection. The researchers tested the actions of alcohol in HCV replicon — viral HCV-ribonucleic acid or HCV-RNAs that, when introduced into human liver cell lines, replicate to high levels. In separate laboratory experiments they showed that
alcohol increases HCV replication at least in part by upregulating a key cellular regulator of immune pathways and function known as nuclear factor kappa B (NF-κB);
alcohol inhibits the anti-HCV effect of interferon-alpha (INF-α) therapy; and
treatment with the opioid antagonist naltrexone abolishes alcohol actions.
Wenzhe Ho, M.D., and Steven D. Douglas, M.D., Department of Pediatrics, University of Pennsylvania, and the Joseph Stokes, Jr. Research Institute at The Children's Hospital of Philadelphia, and colleagues in the Department of Psychiatry, University of Pennsylvania School of Medicine report their results in the July 2003 issue of Hepatology (Volume 38, Number 1, pages 57-65).
Speculating that alcohol somehow promotes HCV expression, the researchers relied on a recently available cellular system for studying the dynamics of virus replication (developed and provided to the investigators by Drs. C. M. Rice, The Rockefeller University, and Christoph Seeger, Fox Chase Cancer Center) to demonstrate for the first time that alcohol enhances HCV replicon expression at both the messenger RNA and protein levels. In the cell lines used for the study, the research team also showed that alcohol activation of NF-κB was responsible for increasing HCV expression. "Although the replicon system mimics only some aspects of HCV replication, we have identified at least a likely mechanism whereby alcohol increases viral load and thus may become an important cofactor in HCV severity," Dr. Douglas said.
"These findings are immediately useful to clinicians for counseling HCV-positive patients about alcohol use," said Ting-Kai Li, M.D., Director, National Institute on Alcohol Abuse and Alcoholism (NIAAA). "For clinical and basic scientists, they raise new research questions, many of which no doubt will be explored using the model and methods introduced today." NIAAA supported the experiments through a grant to Dr. Douglas, whose work also was supported by the National Institute of Mental Health and the National Institute on Drug Abuse (NIDA). The NIAAA and NIDA supported Dr. Ho's work on the study.

[drofi]

Alcohol Alcohol. 2006 Sep-Oct;41(5):546-52. Epub 2006 Jul 19.  
Alcohol consumption within the context of hepatitis C: a qualitative study of non-problematic drinkers.
Stoller EP, Hund AJ, Webster NJ, Blixen CE, Perzynski AT, McCormick RA, Kanuch SW, Dawson NV.
Wake Forest University, Winston-Salem, NC, USA. ***@****
AIMS: Little is known about how non-problematic drinkers respond to advice to reduce alcohol consumption as part of disease management. In this article, we examine patient reports of drinking behaviour after being diagnosed with chronic hepatitis C, a condition for which alcohol consumption is contraindicated. METHODS: In this qualitative study, we analyzed transcripts of semi-structured interviews with hepatitis C virus+ (HCV+) patients whose level of alcohol consumption would not be considered problematic in the absence of their diagnosis. RESULTS: Most respondents reported some instances of adherence, but only half adhered to the advice to limit drinking consistently over time. Respondents who did not stop drinking often modified their behaviour by changing the type of alcohol consumed or limiting drinking to particular occasions. CONCLUSION: Most informants understood the risks of drinking after HCV infection, particularly in the presence of symptoms, with the onset of complications, or when undergoing treatment. But some believed they could monitor their bodies for evidence of disease progression or that drinking was acceptable during early, asymptomatic stages of infection. Our results also identified situations in which patients need support in adhering to intentions not to drink, including social pressures, stressful situations, or environmental triggers.
PMID: 16855001 [PubMed - indexed for MEDLINE]

http://tinyurl.com/26y9vt
Chronic Alcohol Consumption Impairs Immune Response to HCV

Conclusion: In conclusion, the authors wrote, "Altered DC function is one of the major changes induced by long-term ethanol consumption, which subsequently impairs the cellular immune response necessary for viral clearance."
Liver Research Center, Rhode Island Hospital and Brown Medical School, Providence, RI. 03/30/07
References
C Aloman, S Gehring, P Wintermeyer, and others. Chronic Ethanol Consumption Impairs Cellular Immune Responses Against HCV NS5 Protein Due to Dendritic Cell Dysfunction. Gastroenterology 132(2): 698-708. February 2007.

[CockSparrow]

I was going to stay out of the Alcohol debate. I've stated my view before.
Having 1 or 2 drinks a night and no more than 7 per week with at least 3 days off aint going to do much harm. There is no evidence at least.
If your liver damage is F3 or greater maybe not wise to drink at all.

I just had to say to Gigi that giving up alcohol isnt that hard. Take Interferon (it works with HepB kinda). Alcohol stops IFN from working or at least working as well, so when on Tx dont drink anything. With HepC Alcohol can also contribute to steatosis not sure about HepB but alcohol can cause Fatty Liver on its own.
My point is that if I can stop drinking because the Drugs and Alcohol dont like each other, then all that is really required is a reason. HCC is a good reason. from stevenNYer post.

Jim - can we continue the Fibrosis discussion in another thread.
CS

[stevenNYer]

Thanks for pointing this out: "A DNA virus like HBV is a lot trickier than an RNA virus like HCV".  Since drinking is a hot topic, let me add a HepB perspective for anyone who is interested (copied from my post to Gigi1913):

Studies have found that men with unmonitored HepB had a 40% chance of developing liver cancer.  Women 15%.  These studies were done many years ago in Asia where many have HepB.  Now the doctors are saying that one of the reason is that Asian men drink and smoke more than woman.  Makes sense to me.

You also have to understand that when alcohol enters your body, the hepB virus actually don't like that.  It hurts them.  What do they do? they reproduce more to compensate.  So alcohol is killing your liver cell and the many many more virus are invading your healthy liver cells.  Not a good thing.  

Lastly, when alcohol and the HepB virus kills off liver cells, your liver cells regenerate right.  HepB is a DNA virus, it messes around with your liver's DNA, and it could affect your liver's DNA instructions for repair and regeneration control over time.  Although this is low risk, it could also lead to cancer.  That is why cancer could occur without cirrhosis.  Keep the need for repair and regeneration low.

[Gigi1913]

Thank you for the response.  

I think my post does imply that I'm an alcoholic, but I'm not.  I realize that I did go through a phase in my life- after a bad divorce in which I drank excessively, but I dealt with those issues.  I did stop the heavy drinking.  When I was diagnosed, I was told i could have a few drinks a week - no problem.  I find it hard to stop because i have a career that involves lots of drinking activities every single week- 4 nights a week- so the temptation is always RIGHT in front of me. I'm not trying to make excuses- but its hard to suddenly stop doing anything when its all you've ever known.  Smokers find it hard to quit when they know it could kill them, and obese many people find it hard to stop eating foods that are bad for them.    

Also, from what i gather, based on my very low viral load and normal liver function tests, my doctor is being overly cautious.     I'm a complete foodie and in every other way an absolute health nut who loves great  organic/natural food and great wine- I guess I need to develop a love of nonalcoholic wine!    

I go out every single weekend- and don't drink- not since May. But I have had the occasional drink at work events.  And since starting the med, I  had two glasses of wine at two separate work events last week.  My major slip happened this weekend- I had 3  4oz glasses of bubbly at brunch on sunday with my boyfriend.  I really don't think that makes me an alcoholic, but I do think I have major will power issues (I also battle with chocolate on an almost daily basis- the chocolate- be it organic- usually wins).

At any rate,  I do want to stop while I'm on baraclude.   So I will continue to work towards that goal.  It will suck being in Geneva and Paris an not enjoying a glass of good wine!  Lets pray I can survive.   I'll post my progress.. thanks again....

[desrt]

Sorry I can't help you with the precore mutation question. There are a couple people on this board who are hep B savvy, and if you repost you're question on a new thread they can probably help you. A DNA virus like HBV is a lot trickier than an RNA virus like HCV. Most of us here are/were HCV infected.

As for the other, speaking for myself, if I had active hepatitis virus, was told not to drink, swore I wouldn't drink, and still did, I would get myself to the nearest AA meeting.
But that's just me. Good Luck.

[Gigi1913]

Hi,

I'm new to this forum and very glad to find it.  Here is my story:
  I was apparently infected was HepB as a child (born in Africa- came to us age 4), but only found out recently. I was vaccinated at age 17 by boarding school without being tested.  I was just diagnosed a little over a year ago at age 29- but the "so called" specialist I saw at that time said since my liver functions are fine and my viral load is so low ( less than 5K copies), i didnt need treatment or to stop drinking- so long as i didn't binge drink- WRONG !  

I got a new specialist this May and she scanned my liver- which was fatty;  then biopsy- which was scary- traumatic, etc.  No scarring, but some "inflamation"- but i really think its cause i was a super heavy weekend  drinker up until a year ago- the kind of girl at the party that blacked out.  I also drank 3-4 nights a week  at work related cocktail parties and happy hours - usually 2-4 glasses of wine or bubbly- until the new specialist told me to stop cold turkey.  

Now Im on Baraclude - but it took a long time for my insurance to clear and I was on travel for part of the summer so I just started taking it 2.5 weeks ago.  Its pretty easy- tiny pill- no side effects...

I have to admit I've had a few drinks- 2-3 glasses of wine- 3 times since taking it- which i swore i wouldnt do... I'm working on it quitting.  Any suggestions? I really want to quit, but my social and professional lifestyle makes it very hard.  I actually tried to buy nonalcoholic wine at Trader Joes and i thought- how lame!  Why should I quit cold turkey?  There will be a cure soon, right?  I know I sound like a total idiot, but I'm really not.  I dont want to totally give up my life.  I am going to Europe for two weeks on Thursday and i cant figure out how i'm going to avoid drinking!  Its pretty pathetic and i'm very ashamed.  At this point I need to hear from other people experiencing this.  Thanks...

Also, what does precore mutation mean?

[FlGuy]

A minister sees a little boy from his church in the market.  The boy is holding a loaf of bread in arm and his other hand is in his pocket.  The minister says to the boy 'I see you are holding the staff of life".  "What's in your other hand?"  The boy replies "A loaf of bread, Reverend"

[pigeonca]

My brother just told me that if you chew the heck out of a piece of bread as you eat it, you can easily flunk the .08 alcohol test and get a DUI.  So maybe our daily bread is a vice.

[FlGuy]

Think it was Ogden Nash:

Candy is dandy but,
Liquor is quicker