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172336 tn?1202258241

Alcohol Pre Treatment

I went for my pre treatment psych eval earlier this week. Found out that the docs don't want to start treatment unless the patient has been alcohol free for at LEAST six months prior. I was SO disappointed as I was hoping to begin tx ASAP.
I enjoy a glass of red wine with dinner. I knew NO alcohol during treatment and had planned to not drink for several weeks prior to.
Now I may be delayed into the new year befor I can start tx.
I just wanted to share with those of you who haven't started tx yet so that something like this doesn't hold you up as well.
57 Responses
80575 tn?1207135964
Be prepared for the wrath of hell about using alcohol with HCV.  It's a very emotional topic on this board.
108191 tn?1199603505
I'm sorry that you have to wait.  Can you get another doctor?

When I went for treatment I was asked how much I drank per week.  I can't remember actually how much I said, but it wasn't an issue, they treated me.  However, I have one friend who had to be alchol free for 6 months.  It depends on who is treating you it seems.  

If it were me I would get another opinion if you are able to.

Avatar universal
What nonsense!  Sure, its BETTER if you aren't drinking and I certainly advise my patients not to drink more than 7 standard drinks per week (in fact, alcohol consumption at that level or lower is a prerequisite for funding therapy in Aus), but there is little evidence to suggest low level social alcohol consumption of this sort impairs your response to treatment in any measurable way or accelerates your liver disease (assuming you don't have an alcohol PROBLEM or alcohol related liver disease to start with. We are supposed to practice "evidence based medicine" and I would LOVE to see any evidence that getting people to be completely abstinent for 6 months prior to treating HCV with IFN/Riba makes any difference to outcome (other than the fact you unnecessarily delay therapy)

It is also not realistic. If I insisted on this, I'd wind up treating about 25% of the patients I have. The Puritans have a LOT to answer for.  Several patients I currently treat also tell me that 1-2 glasses of wine (on the nights they inject, only) actually makes the side effects more tolerable.
Cheers,
Sonic
108191 tn?1199603505
That's wonderful - you being a doctor!  Your views and experience are a welcomed asset on this forum.  

If you don't mind - what type of doctor?  You may have posted this, but I may have missed it.
Avatar universal
Amen! Mike
Avatar universal
I have heard that some doctors have the 6 month no alcohol rule but mine didn't mention it.  IF somebody is only a casual drinker ie-has a glass of wine with dinner every now and then- how would the doctor know they  have been drinking?  Surely, they could pick out the alcoholics from simple blood tests.

I think the rule is totally understandable when dealing with alcoholics.  
151263 tn?1243377877
Alcohol consumption has been shown to increase viral loads in those infected with HCV. I don't recall offhand what threshold of alcohol consumption would start making the biggest difference in increasing VL, but I'm doubtful a very moderate alcohol intake (like 1-2 glasses of wine a week) would do much to increase your viral load.

I'm guessing the reason they want complete abstinence for 6 months prior to tx is for two reasons: (1) To ensure you're capable of abstaining and controlling any possible addiction you might have. Abstinence will help you adhere to your treatment protocol and thereby help to improve odds of treatment success. Alcohol consumption during treatment will further tax your already taxed body and mind, making you less likely to comply with and complete treatment - thereby lowering your odds of treatment success. It can also greatly complicate the management of your emotional side effects. Anti-D's and sleeping meds are common meds used for the management of sides. Generally you don't want to be mixing White Zinfidel with Paxil, ambiem, Tylenol, benadryl, interferon and ribavirin just to name a few.

And (2) to keep your pre-tx starting VL as low as possible. Eliminating alcohol consumption well before starting tx will help to get your viral load down and "re-equilibriated" as low as you can get it prior to starting treatment. Studies have repeatedly shown that those who start off with lower viral loads tend to respond more favorably to the treatment drugs. Those who start out with lower viral loads are more likely to go UND earlier and are generally more likely to get their SVR after completing their treatment. Anecdotally I've seen people report very significant reductions in their VL after stopping alcohol.

So while it's a bit of a mixed bag, in this layman's opinion it's probably best to just stop alcohol altogether well prior to starting treatment. If you're a very moderate drinker (i.e. 1-2 drinks a week), I'd just go 3 months without any alcohol prior to starting tx. I'd also use that time to get into shape - eat right and exercise plenty to strengthen yourself in preparation for your battle. If it's real hard (or impossible) for you to stop drinking, then I'd suggest trying getting the help required to get the alcoholism under control. SOC treatment can be a real tough fight for someone without any addictive monkeys on their backs. Treating while suffering from unmanaged alcoholism is setting the stage for failure, and one hell of a miserable experience. My $0.02 anyway, best of luck.
Avatar universal
Most alcoholic still in denial will tell you they're only casual drinkers.  Most in recovery will jokingly tell you that they casually drank, just that they casually drank when they were happy, casually drank when they were sad, or casually drank when they were neither happy or sad.

Most doctors can discern the occasional drinker from those who casually drink.
172336 tn?1202258241
I am treating with Dr Fried's group here in the US.
I told them I am completely a casual drinker ( 1-2 glasses of wine at dinner) the 4 oz glasses not the GOBLETS!  lol
I am geno 1-a
O fiobrosis
grade 1 inflammation

I'm a bit frustrated to say the least
Avatar universal
What about cooking with wine? Is this just as bad as drinking it?
Avatar universal
Hepatologist. (Aus/UK/US trained MD PhD)

Actually, some hepatologists I know (and who have published on this contentious subject area) will treat HCV in people actively detoxing from heroin on maintenance methadone.  I have issues with that but their stance (and I can't argue with it) is that many of these people will get off drugs but if you wait for that to occur before treating them you may delay therapy too long.  Tough area to work in.

Sure, high levels of alcohol consumption will increase (to a minor degree, not by the 2-3 logs IFN/riba causes it to fall by) viral load in some people, but modest (1-7 units / week) have never been shown to impair responses to therapy.
Cheers,
Sonic
96938 tn?1189803458
In most cooking processes, the alcohol in wine is 'cooked off' or evaporated in the processes.
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