nicole_1234:
My doctor told me they were testing me for alcohol and marijuana because of the cost of Harvoni, they do not want to take the risk to give the medicine to someone who might handle it irresponsibly. You are right that is discriminatory.
I agree that alcoholism is a disease and not someone just being "crazy" to drink, and they deserve to be treated as much as someone who's an addict with cancer deserves access to chemotherapy. My father was an alcoholic who battled it his whole life and died at 67 from cirrhosis. He also had Hep C and the who knows if he could have lived much longer, even still drinking but without the Hep C??
Although, if I were a doctor I would try to get someone in to treatment for addiction first before starting Harvoni or at least at the same time because I think it can't be helpful if you are drinking heavy amounts while trying to cure Hep C.
I choose not to drink alcohol at all or even take herbal supplements or anything that could interfere. Alcohol (and sugar, fried food) definitely taxes your immune system whether it interferes with Harvoni or not and I'm trying to give my body optimum strength to fight this.
MEG:
Thanks for posting that, Mike.
Not sure how much this analysis helps. Going by metastudies can be a problem unless you can see the studies they looked at to ascertain they all had uniform rigorous testing or not.
We know that hcv titers are all over the place...did these studies note trends of viral titers for each patient? For example, I've been running 500K+2million over 20 years.
Those p values are not strong. Anything above 0.05 is worrisome re: any conclusions they make.
Do you have a link to this paper? I've been doing pubmed and google searches and have not been able to find anything.
I am also a nurse and although I am not working I would want to know not only for myself but to prevent my giving wrong information to any other person with HCV that I may interact with outside of the online boards.
MEG:
Nicole,
I'm so sorry you lost your dad at such a young age. My uncle died of his alcohol induced cirrhosis at age 56. He was an amazing person. I still miss him. Several in my family struggle with it and dear friends, who are wonderful people, struggle with it every. single. day. My addictions are different. Cigarettes---chain smoker. And it took getting bed-bound sick with this virus for me to quit. I still want one every day. And do relapse from time to time. I have absolutely no judgement of addicts of whatever substance...
--- Quote ---Although, if I were a doctor I would try to get someone in to treatment for addiction first before starting Harvoni or at least at the same time because I think it can't be helpful if you are drinking heavy amounts while trying to cure Hep C. --- End quote ---
I know of some doctors and medical centers that try to get people in treatment before beginning hcv therapy. I don't know how across the board it is around the country. I suppose it depends on resources available.
I feel the same as you---since diagnosis, my aim has been to remove as much burden as possible from my liver so it can 'more energy' to fight the virus.
Not everyone manages illness in the same manner and that's ok.
MEG:
Mike, this MD from Boston University explains the concerns about metastudies and in particular this one much better than I was able to articulate.
--- Quote ---Comments: This meta-analysis did not find a consistent association between alcohol use and hepatitis C virus replication. The conclusions from this study are limited due to its small sample size, differences in how studies defined heavy drinking, the cross-sectional analyses, and lack of control for the quality of the studies, duration of alcohol use, and antiviral treatment. However, while the mechanism of liver damage from co-occurring hepatitis C and heavy alcohol use remains uncertain, the recommendation for patients with hepatitis C to abstain or minimize alcohol use remains unchanged.
Kevin L. Kraemer, MD, MSc --- End quote ---
Mike:
Here's a summary of research conducted by the VA:
"Hepatitis C and Alcohol
Alcohol and hepatitis C are certainly the two primary causes of cirrhosis and liver transplantation in the United States and Europe.(1,2) Many patients with hepatitis C from these regions also have a history of problematic alcohol use, and thus have liver injury from both agents. An unequivocal first step in the management of patients with HCV who have an “alcohol problem” is ensuring that alcohol cessation is put in place. This section describes what has been shown about the interaction between alcohol intake and chronic hepatitis C infection.
Several factors have made this area of study difficult:
* the fact that alcohol intake varies over time in nearly everyone, and is thus very difficult to quantify
*alcohol likely affects individuals differently (for example, it seems that only 20% of heavy drinkers develop cirrhosis).(3)
These limitations should be considered in the interpretation of the studies discussed.
Alcohol and Liver Disease in Patients with HCV
Since the discovery of the hepatitis C virus in 1989,(4) heavy alcohol consumption and hepatitis C have been known to interact with each other in causing liver disease. Poynard et al (5) were among the first to demonstrate that heavy alcohol intake (50 grams/day or more in their study) contributes to fibrosis on liver biopsy in patients with HCV independent from other predictors. This intake is equivalent to 5 or more drinks per day (an average "drink"--one 12-oz beer, 5 oz of wine, or one 1.25 oz shot of hard liquor--contains approximately 10 grams of alcohol).
Numerous other studies have confirmed that heavy alcohol intake contributes to HCV-associated liver disease. Notable among them is the study by Roudot-Thoraval et al, which evaluated more than 6,600 patients. Heavy alcohol intake in this study was associated with significantly more cirrhosis than was smaller amounts of alcohol intake. Another important study was that of Ostapowicz et al,(7) in which patients with HCV who had undergone a liver biopsy had a detailed lifetime alcohol history obtained. Daily alcohol intake was not associated with fibrosis in multivariate analysis, but patients with cirrhosis had greater total lifetime alcohol consumption than did patients who did not have cirrhosis.
Limitations of studies published to date have included grouping subjects by fixed categories of alcohol intake,(5) and using case-control methodology, with cases often having cirrhosis and controls having little liver disease. Studies including light drinkers have had conflicting results. Ostapowicz et al (7) found no significant relationship between light or moderate alcohol intake and fibrosis on liver biopsy."
The research suggests that moderate to heavy alcohol consumption (2-4 drinks per day), in some infected by HCV, can accelerate liver damage. However, the research does not address occasional alcohol consumption of 1 or 2 drinks per week, and it is doubtful that this amount would cause any damage.