Alcohol and HCV...an unanswered question.

[DoubleDose]

Here is a curveball, along with an article regarding the highprevalance of HCV in alcoholics.  See link below.

http://www.nih.gov/news/pr/jun2003/niaaa-26.htm

This is an issue that I have discussed with several HCV doctors, with no clear answer to my questions.  The article, as well as several others I have reviewed lately, indicates the abnormally high number of heavy drinkers, alcoholics, etc. that are HCV positive.  Often this is within populations with no known risk factors, and no past IVDU history.  My big question, which I have wondered about for years, is WHY does this seem to be the case.  Why would heavy alcohol users seem prone to developing HCV???  Unless, of course, they are all lying, and happen to also have risk factors which they now deny.  I think there is much more to this mystery, which still baffles the medical community.

Along with my concerns about persistent HCV after SVR, is another concern which many of you have responded to in the past when I have posed this issue.  Could there be HCV transmission in the general population, on a much larger scale than suspected, that is not in the bloodstream or liver.  In effect, a 'latent' tissue, or glandular infection which remains latent or suppressed, until a major stimulus causes it to 'explode' into the bloodstream.  This theory would help explain the great numbers of HCV cases worldwide that have no known risk factors.
Could there be a somewhat 'dormant' viral infection in a large portion of our population, within organs like salivary system, sexual organs , membranes, CNS, etc.??? (cont. below)

[DoubleDose]

This would mean that an immune suppression event, major illness, or extended alcohol abuse might cause the 'latent' controlled tissue HCV infection to overwhelm the immune system, and allow it to be expressed in the bloodstream and liver.  This might fit the pattern of many HCV positive people, who discover that they have the disease, but have no clear risk factor in the past, other than maybe a period of extreme alcohol abuse.  It would also explain why alcohol is a major problem to those with ongoing HCV in the blood as well.  It continues to 'explode' production of HCV, and to overwhelm immune defenses, so that fibrosis, and cirrhosis, and eventually HCC develop.

This is the only logical answer that I can come up with if the alcoholics studied truly do not have a higher frequency of risk factors than the HCV-negative alcoholic control population.

Any thoughts on this issue????  

DoubleDose

[jmjm530]

"In effect, a 'latent' tissue, or glandular infection which remains latent or suppressed, until a major stimulus causes it to 'explode' into the bloodstream. This theory would help explain the great numbers of HCV cases worldwide that have no known risk factors."
--------------

Personally I think the reason so many hep c cases have "no known risk factors" is because many infected from IV drug use -- still the leading cause here -- aren't honest with their treatment doctors. The second reason is I think is that sexual transmission (or intra-familial transmission) may be underestimated. Sex and drugs, drugs and sex, two topics people tend to keep private. No, have no studies on this, just an opinion.

Oh, and just to be clear, I'm not talking about anybody here, so please do not respond personally :) I know there are other less conventional modes of transmission as well. However, DD, with respect, I don't think your "exploding" viral into the bloodstream is one of them.

-- Jim

[jaroman]

I have long believed that we all harbor pathological viruses that are "latent" and waiting to multiply upon presentation of a trigger.  Like HCV triggered by alcohol abuse.....
Hope I am very mistaken.

[friole]

Tend to agree with Jim here.  I think the percent of those that are honest about how they have contacted HCV is very small. I just can't subscribe to the osmosis method of HCV transmission. Perhaps like Jim said there is more sexual transmission than originally thought, but I am not even sure of that.  I still think the blood to blood contact is how we all got it. Sorry, DD.

friole

[johnisme]

When i was younger and tougher i did a lot of construction work, and my fair share of ironwork. If you didn't leave the job site at the end of the day with some good size cuts and nicks on your hands and arms then you must not of worked very hard. And you know that maucho image that men have, you didn't stop working over a boo boo you just grabed a rag wiped the blood off, tossed it aside and kept working. I often wonder now how many people that used that same rag that i tossed got infected from my blood. There are so many ways for blood to blood infections that we don't even think about at the time. But i don't think that explodings viral in the bloodstream is one of them. But thats only my thoughts.

                               John

[azgrl]

I do believe there are a handful of people out there who are not honest with their drug use although I don't think all those that can't figure it out fit in that category.

As mentioned before there are other possibilities to look at such as dentist office, nail salons, dr offices that do minor procedures in their offices, remember not all health professionals are careful.  Look at what I just experienced a week ago.  There was a nurse (very old) who wiped a spot of my blood away with her bare finger.  (She was reported by the way) There is also the chance of contracting hepc via transfusion even now.  There is no way to test if someone gives blood within the "incubation" timeframe of being exposed.  there is still a 1 in 121,000 chance of getting it through a transfusion.  With all the knowledge we know I still got it from an in utero transfusion when I was pregnant in 2002.  We went through 16 of them my doctor is sure this where it came from because in 2001 prior to a transfusion with another pregnancy I was tested (I didn't even know) and was negative(We investigated all my medical records) So there are still many many possibilities out there.  Alcohol, I think, is just one common denominator they can determine.  They haven't found the other one yet.

But this is still all new to me so these are just my humble thoughts.

Deb in AZ

[cougareyes]

John is right, through the 70's and alot of the 80's we just didn't worry about blood as much. Just a quick story, my friend visited from another city; getting ready that night forgot his razor; used mine. We would never do that now. At the time I did not know I was HCV, thank goodness he is negative today.
As far as alchol, had I not been such a heavy drinker; I'm not sure I would know now that I have HCV. The accelerated alcohol use with the HCV is what made me sick. I don't know exact numbers, but there are alot of non-drinkers that have HCV, alot of heavy drinkers w/cirrosis that don't have HCV; and every other combination in the book.
If you look hard enough you'll find your category if you really want to; I still don't really know how I got. Didn't shoot drugs, but did believe in "sex, drugs, and rock-n-roll.
Peace

[mistybean]

Not sure that thier is a cooralation between high drinking and non-blood contact.  The highest population of Hep C infected are ex or current drug users.  I have heard this number is as high as 70 to 80 perect of those infected. It is possible that they are also heavy drinkers.  I have never met a drinker who did not have another risk factor related to blood who is infected with hep C.  I think it is clear that the highest risk factor for getting Hep C is via blood contact.   What you do see is a coralation between heavy drinkers and advanced hep c ( approx 20 percent).  This is the same percentage of people who will get advance Hep C.

[mistybean]

I don't believe latent Hep C is triggered by alchohol use. Alcohol use does not start this virus or trigger the virus to become active.  Two different things completly. cheers

[mistybean]

My father was an iron worker in San Fran and thier was lots of drugs and drinking moving with that crowd in the 70"s and 80"s.

Kid of an ironworker

[johnisme]

The first thing we found out at any new job site was where the  nearest liquor store was. And the owner would always keep plenty of quarts of beer on ice for us. And when they would bring a new guy on the job all we had to do was look at his hands. We could tell how long he would last.

[cougareyes]

That's where and when I got it. In 1980, San Francisco; I was diag. with non-A/non-B hep, I thought I was cured. I never thought about it again until Oct last year when I was diag w/ HCV.    Peace

[Forseegood]

hmmm, generally speaking, would practicing alcoholics be the "go to" population for personal honesty, forthrightness and clarity? dunno about that. I believe many of them would probably be less than forthcoming about any IV drug experimentation, hence the skewed numbers. Alcohol use, even in excess, is much more accepted in most societies.

I know I've said this before...but I've gone to so many hep c boards and I've spoken with or read so many posts from hep c patients on boards or hep c support groups....and I've never spoken to one person who thought they might have contracted this sexually. There have been a few that have said they didn't know how they contracted it, maybe there's something to that.

But then I've spoken with or heard of so many people in relationships of all kinds and marriages...who have significant others' who never contracted it from their partners. Lots and lots of couples out there where one person has it and the other one doesn't. I just don't think it would bear out that there is some significant probability of contracting this sexually if this is the case for me and so many people I know. Maybe I'm dead wrong about this, but it doesn't add up to me. I've spoken to a few hepatologists who feel as I do about this. Until I see a lot of evidence to the contrary, I think this is for the most part a blood borne disease.

[johnisme]

I never did any iv-drug use, but at that time in my life i did pop a lot of black beauties.

[susan400]

I'm still in the belief that it's blood borne.  Alcohol would negate that, unless you have a bloody mouth and share a cocktail with someone with a cut on his lip??  I do believe that alcohol definitely puts fuel on the fire.  I also don't believe that the sexual transmission factor is that big of an issue.  I've know too many people in long term relationships where the partner/spouse, never turned positive.  The exception to the rule, I think is with anal intercourse w/o a condom.  In that instance, I could see the sexual transmission factor to be greater.  

Just IMHO.

Susan

[Forseegood]

Yeah, I'll fess up, I tried those too back in those lazy, hazy, crazy days of summer... kept the tubes on the back of my refrigerator sparkly clean though!

[mistybean]

I got my hep C most likely in san jose,ca.  I did hang out with many from the city.  I got mine most likly in 77 or 78.  IV drug use was the reason and I was just kid at about 16 years of age or so. I am genotype 2a what you is your geno?

[cougareyes]

I'm a 1a, 22/48 pegasys/1200mg copegus. Starting vl 1.05mil, undetectable at wk 12. Started at stage 3/ grade 3 w/fatty liver.
I was 19 years old hanging out in North Beach and the Tenderloin of S.F. singing in punk rock bands. So you know the scene I'm talking about. I'm just lucky I'm not already dead, and at least I didn't get HIV. It was running rampant at that time. If we only knew then what we know now, aah it wouldn't matter; I have no regrets. Better than looking back bitterly at a boring uneventful life.   Peace

[johnisme]

Yeah, i agree cougar. No regrets here. I was young making good money and living in south florida. Life was good.

[BostonGirl]

Hey Mistybean;
             You mentioned that you probably got infected in San Jose. Do you still live in the Bay area? I am in the Santa Teresa area. Hubby works for NASA Aimes research center( Mountain View ) Just curious. (((( Sue))))

[sailinlady]

When I was first diagnosed with HCV I read some where that it was traced back to blood samples from WW2.  Does anyone know anything about how far it has actually been traced back?  Is it simply because we don't have acurate blood samples prior to WW2 to test?  How long has this monster really been around?  Better yet, where did it come from?

I have to believe if only for my own sanity that it is blood borne only.

[GoofyDad]

In 1980, San Francisco; I was diag. with non-A/non-B hep, I thought I was cured.

Me too pal!

[debdeb47]

What blows my mind as to transmission is why more regular IVDU's aren't multi-genotype/subtype/quasispecies-infected.  Honest to god I had one single iv stick w/ two users, so I guess my viral pool was their viral pool. (Venice Beach, '80-82, 2b, f 48y/o 1/1 13/24)

Of course so many people shared $100 bills; why am I not multi-infected from that?

[DoubleDose]

Responses very much appreciated!!  I enjoy the input, and opinions.  Again, my comments were very speculative, and by no means presented as a firm belief...only a suspiscion...and an explanation of an odd set of statistics.  Bear in mind, I was not saying HCV transmits to the blood by sexual contact, or other tissue contact....only that it might remain in compartmentalized tissues, as a latent infection.  Only in extreme cases (the heavy alcoholic) would it then cross the blood barrier.  This was my speculative theory...and I am not at all claiming that this must be happening.  Only a potential, possible answer to the puzzling fact that many alcoholics seem to be HCV+.

Of course, they may have become infected through typical blood to blood contact, and might have a tendency to be less than truthful about IVDU issues, etc.  I agree with all the above comments, but the answers to this question are not at all clear, as the article points out.  There are lots of things relating to this virus that still seem to baffle the researchers, and the HCV medical community.  One by one, we will want to find the 'exact' answers to all of them.  I remain an optomist...but still have lots of questions and concerns...based on my own experiences, and observations of others out there...along with what I am reading in the past few years.

I am really hoping that research proves that HCV is 'gone', eradicated entirely from our bodies after we get a solid SVR, and that the odd findings that have been cropping up in research studies, are all explained by some 'viral remnant' or 'viral memory' type reasoning.  Maybe there is no cause for concern at all.  But the jury is still out.

And on some questions (such as tissue to tissue transmission) the jury is not even in the courtroom.  There are no real questions being raised around this issue at all, so maybe it is not really an issue.....at all.  Let's hope.

DoubleDose