Hep C Discussion Forum

LamontCranston · Senior Member

Alcohol after successful treatment.

Tig · Admin

The people inclined to hit it hard and enjoy hitting it hard, are better off staying way away from it. Of course anyone with advanced fibrosis or cirrhosis, should just consider it out of the question. Sounds like you were never a serious drinker, so a short one next Christmas probably won't throw you over the edge! That's not permission, just an observation! wink

HepCGtype2 · Senior Member

Interesting topic.

Never been a drinker. I had 2 glasses of wine last Xmas but think it must have been 4-5 years before that since the last.
I didnt stay away because of Hep C but I am just not inclined that way.
But even those odd 2 I still was aware that it might hurt my liver.

4 weeks into treatment, but my level of scarring was the lowest, I was told.
Well maybe one next Xmas

wendyo · Guru

The way I look at it is I was given a gift from God and Gilead and I would not want to possibly destroy that. I never want to have to go through this again. (just me) Similarly, I just a week ago wrote my gastroenterologist who I have been with for 16 years and asked their thoughts on me taking black cohash now that I am cured. They took the time to look up my records and comment on my previous biopsy results, sent info for me to read and discouraged it but left it up to me to decide. And I decided not to.

Tig · Admin

I was just asked about drinking once treatment is over and successful. I thought this thread, while a couple of years old, still holds true. I want to add some additional information from the Mayo Clinic. I don't recommend drinking alcohol ever again, especially for those with advanced fibrosis and cirrhosis. Consider your choices wisely...

How safe is it to drink alcohol socially after being cured of hepatitis C infection?

Answers from Stacey A. Rizza, M.D.

Unfortunately, it's impossible to say. No research has addressed this particular question. As a general rule, though, anyone concerned about liver health should avoid alcohol.

Hepatitis C-related liver scarring (fibrosis) often lasts long after treatment, as does severe fibrosis with abnormal cell regeneration and vessel formation (cirrhosis). Even when you're no longer infected, drinking alcohol may promote the progression of fibrosis or cirrhosis.

It's also possible to have a relapse of hepatitis C infection long after apparently successful treatment. Such relapses appear to be quite rare. But because alcohol is known to worsen hepatitis C-related liver disease, the remote possibility that the infection may return is further reason not to drink.

With Stacey A. Rizza, M.D.

Drinking: Is it Safe after Treatment

js · Member

Hi Tig! Can't wait to start spoiling! Health is good, getting better everyday. Coming up on my 1 year EOT...and still SVR at 9 mos. One fun thing about the new outlook on life is I get to paint the house! What fun...not. Hope all is well with you. Sorry for the thread drift folks.

Tig · Admin

Hi Scott,

Good to hear from you! Just want to wish you the best on the upcoming birth of your first grandchild. My first turns one in July and I can't begin to describe the joy she has brought into our lives! I hope you're doing well and enjoying life =-)

js · Member

I am enjoying my life too much now that I would ever want to take a drink and risk my new found health. Dont give a damn if you want to drink, none of my business. I will frolic with a slice of mince pie before bed on an auspicious occasion, but I dont make a habit of it. To each his own. My first grandchild is due in August and I am just so thankful that I am here so I can properly spoil the child. Drink? I think not.

mallani · Guru

Bubble,

Aspirin is an NSAID, but not a very good one. Tylenol (actaminophen- paracetamol etc) is good for pain and fever but has no anti-inflammatory action.

Both Tylenol and the NSAID's can damage the liver in inappropriate doses. The most common cause of acute liver failure in Australia is NSAID overdose.

NEVER exceed the recommended dose. Cheers- back to good old alcohol.

bubble · Senior Member

So Sorry, Did not mean to hyjack.

Tig · Admin

Hey Bubble,

I don't want to change the topic off alcohol, but welcome you to start a separate thread if you want to pursue additional conversation on it. Here's some starter info:

http://emedicine.medscape.com/article/820200-overview

bubble · Senior Member

Malcolm, I did ask my Hepatoligist about taking NSAID's and he said I could take normal amounts of asprin. I also asked anout Tylenol damaging the liver but he would not budge either way on it. That was an age old myth in the states that it's no good for the liver. Although I heard asprin takes longer to leave your system than Tylenol. Hmmmm? Anybody on this one?

boostm3 · Member

Tess wrote:
Hot topic! Some see it as a moral issue while others focus on the physical data. It is well documented that anyone with liver damage should not drink alcohol due to the effects on the liver, whether the damage is from HCV or not. What is not clear is if a person with a healthy liver should totally avoid alcohol after successful treatment for HCV. Abstention is absolutely necessary during treatment but afterwards, light consumption is up for debate. Personally, and with my doctors' knowledge, I will have a glass of wine now and then since my liver seems to be in good shape.
I want to say to Paul - - man, you have been through the ringer with your test results! Congratulations that you reached SVR!!! It must have been tough getting those earlier results. It's unusual to not be UND at the end of treatment with Harvoni. To come back with undetected at 11 weeks post treatment is wonderful. Good for you!!!
Best wishes,
Tess

Hi Tess.. Yea, that earlier EOT test was tough; I thought for sure I had failed... Then some kind soul linked me to this study which features the following conclusion:

"Conclusions.Contrary to past experience with interferon-containing treatments, low levels of quantifiable HCV RNA at EOT do not preclude treatment success."

http://cid.oxfordjournals.org/content/early/2015/03/02/cid.civ170.abstract

There were 3 patients on another forum which I frequent which also had low detected viral loads at EOT, who all went on to SVR12 with Harvoni! There were also a few who tested Undetectable on treatment who didnt make SVR12. Thats why on treatment vl monitoring with Harvoni is essentially useless in the majority of cases...

-- Edited by boostm3 on Thursday 28th of May 2015 02:30:25 PM

-- Edited by boostm3 on Thursday 28th of May 2015 02:44:12 PM

Tess · Senior Member

Hot topic! Some see it as a moral issue while others focus on the physical data. It is well documented that anyone with liver damage should not drink alcohol due to the effects on the liver, whether the damage is from HCV or not. What is not clear is if a person with a healthy liver should totally avoid alcohol after successful treatment for HCV. Abstention is absolutely necessary during treatment but afterwards, light consumption is up for debate. Personally, and with my doctors' knowledge, I will have a glass of wine now and then since my liver seems to be in good shape.

I want to say to Paul - - man, you have been through the ringer with your test results! Congratulations that you reached SVR!!! It must have been tough getting those earlier results. It's unusual to not be UND at the end of treatment with Harvoni. To come back with undetected at 11 weeks post treatment is wonderful. Good for you!!!

Best wishes,

Tess

Rubye · Senior Member

Whenever I think about having a drink, I think about HE. I've been so very lucky so far and have only had minimal HE episodes but it's enough to make me aware of how scary cirrhosis can be. So, in my mind,

alcohol = HE.

fourlocos · Senior Member

This is an interesting discussion for sure. I was never a drinker. I do liquor sampling on the weekends and haven't tasted what I pour and sell to people. Some find that odd, I just never liked the taste of alcohol and I am sort of a controlled type person and don't like things that make me feel out of control. That being said I enjoyed smoking pot up until about age 30. So I haven't done that either in 35 years! Now that I know I can't drink, rather than choosing not to, I can see how it would make you want to have a drink. It is human nature to want what you suddenly can't have. But I wouldn't risk any harm to my liver. I still have liver area pains everyday and don't want to pour fire on it. Finding out I had Hep C and probably for 40 years scared me. I didn't want to die that way. I always knew the Big C would get me but it was the wrong C that I was diagnosed with back in November. Came out of left field. Working in the liquor industry is eye opening. People sure love their booze! I want to scream sometimes to be careful with that stuff! But its my job and I do it well. We all make our own choices.

boostm3 · Member

Hi Mallani..

Thank you for your response..

>>Post mortem studies in SVR patients have not shown virus in hepatocytes, but virus has been shown to be present in virtually any tissue.<<

I'm curious, then, why the virus hasn't appeared in liver tissue in post mortem studies?

>> It can obviously replicate or it would eventually disappear. Our tuned-up immune system ensures that viral numbers are controlled<<

Then why did our viral loads grow into the many millions in many cases prior to treatment? Why is our immune system post-treatment able to control the replication in a way it wasnt able to do before treatment? SVR4 is 98.5% predictive of SVR, and SVR12 even more so. Im not really getting how alcohol enables incapacitated, impotent, or missing virus to replicate after theyve been unable to do so for 12 wks or more post treatment? I thought the virus had to replicate in order to be vital.. As you said, if it doesnt replicate, it disappears, and in the case of SVR12, it hasnt replicated for about 12 wks... As for 'hiding', I know HIV hides; Ive read HCV does not...

You obviously have a good grasp of the mechanics of HCV infection, but, I sure wish I could find some evidence in the studies which supports the notion that alcohol can cause a relapse in SVR patients. Without hard evidence, I guess we'll have to believe what we're predisposed to believe, and hope for the best. I thank you for your point of view.

-- Edited by boostm3 on Thursday 28th of May 2015 02:21:29 AM

-- Edited by boostm3 on Thursday 28th of May 2015 02:24:45 AM

mallani · Guru

Hi Paul,

At least I prompted you into posting. I'm always glad to discuss this topic and obviously have firm views. It remains a personal decision.

My take is this. SVR means no detectable circulating virus in the peripheral blood. It's generally accepted that tiny amounts of virus remain- whether hidden in monocytes, fibrocytes etc is still uncertain. It can obviously replicate or it would eventually disappear. Our tuned-up immune system ensures that viral numbers are controlled.

Post mortem studies in SVR patients have not shown virus in hepatocytes, but virus has been shown to be present in virtually any tissue.

Entry of virus into hepatocytes is what we are trying to avoid. This a very complex process but mostly involves the viral envelope glycoproteins, E1 and E2. Essentially, if these are blocked, the virus can't enter hepatocytes- this is what our immune system does so well.

A damaged liver cell is a different matter. Entry is easy. So we try to avoid substances that damage liver cells. Alcohol is one substance.

Alcohol is mebatolised in hepatocytes to produce acetic acid. This generates inflammatory cytokines and NAD (increasing the ratio of NAD+ and NADH). The net result is increased fat and a damaged liver cell.

The NSAID's are nearly as bad. I still worry when I take the occasional Mobic (meloxicam).

This is my opinion and I really don't mind if you disagree. Cheers.

boostm3 · Member

shadow10cats wrote:
boostm3: Alcohol and HepC are too completely different toxins that affect your liver. One is a blood born virus that just so happens likes to attack our liver; the other is a substance we indulge in that our liver has to process & when we overdue it we end up trashing our livers more or less. Drinking has nothing to do with contracting or bringing back the virus as far as I know. If there is any virus left hiding in our body after treatment, and it finds its way back into our blood stream, I don't think it will be because you had a drink. I think the feelings about drinking stem from not wanting to risk damage to the liver. Many may have compromised livers from additional issues besides HepC and the drinking is simply not a good idea for their long term health. Even those like myself, I never had a drinking problem and I never had elevated liver enzymes, the chances of me contracting cirrhosis or damaging my liver by having a drink or 2 is probably minimal to zip. There may come a time when I decide to have a drink but it's not something I am ready to rush out and do as a "celebration" (in as much as a frozen margarita sounds so refreshing right now in this heat!). This whole HepC trip has given me a whole new appreciation for my liver and the valuable job it has in protecting my body. Therefore I simply owe it the respect it deserves and take care of it accordingly.

Right; thats pretty much how I see it.. I dont have liver disease, and am SVR12, so Im allowing myself to enjoy some light indulgence. Its a decision that has to be made intelligently by the individual taking into account liver condition, overall health, and ability to control one's drinking. My purpose in bringing this up, and what really caused me to join this forum and not just 'guest' it was the post below by Mallani who wrote:

"The chances of relapse after SVR are pretty slim. However, if you want to increase the chances, have a couple of drinks."

I mean, can tylenol cause relapse? Sugar? etc, etc. Alcohol is no good for liver disease, but its not supersubstance; it has this boogeyman reputation, but it cant give you virus and it cant cause virus to do things its not capable of doing.

I just had to take issue with the statement that it increases the chance of relapse. ... But hey, at least it drew me into this forum! :)

-- Edited by boostm3 on Wednesday 27th of May 2015 07:17:26 PM

-- Edited by boostm3 on Wednesday 27th of May 2015 07:30:46 PM

bubble · Senior Member

I want to walk my step daughter down the isle and live to see my grandkids. Not a drop for this Buckaroo. Cant this train go any faster???

Gracie · Guru

That is an excellent way to describe why you shouldn't. Respect your liver enough to stop punching it around! It had a round with a heavy opponent, now it deserves a restful retirement!

shadow10cats · Senior Member

boostm3: Alcohol and HepC are too completely different toxins that affect your liver. One is a blood born virus that just so happens likes to attack our liver; the other is a substance we indulge in that our liver has to process & when we overdue it we end up trashing our livers more or less. Drinking has nothing to do with contracting or bringing back the virus as far as I know. If there is any virus left hiding in our body after treatment, and it finds its way back into our blood stream, I don't think it will be because you had a drink. I think the feelings about drinking stem from not wanting to risk damage to the liver. Many may have compromised livers from additional issues besides HepC and the drinking is simply not a good idea for their long term health. Even those like myself, I never had a drinking problem and I never had elevated liver enzymes, the chances of me contracting cirrhosis or damaging my liver by having a drink or 2 is probably minimal to zip. There may come a time when I decide to have a drink but it's not something I am ready to rush out and do as a "celebration" (in as much as a frozen margarita sounds so refreshing right now in this heat!). This whole HepC trip has given me a whole new appreciation for my liver and the valuable job it has in protecting my body. Therefore I simply owe it the respect it deserves and take care of it accordingly.

shadow10cats · Senior Member

NEW ARTICLE RE: Alcohol after successful treatment.

Greg D · Senior Member

RE: Alcohol after successful treatment.

Tig · Admin

Hey Boost,

Yep, thanks for catching that typo! It has been edited. Looks like your odds of success are getting better just by joining our group, lol!

boostm3 · Member

I appreciate all of your responses.

>>You are lucky. To have the virus that many years and only be F/A 0-1 is almost unheard of, and I've been following this stuff for quite some time<<

Just lucky I guess. Actually, Im surprised results like mine are so rare considering that the percentage of HCV patients who live long and symptom free lives is, or used to be, pegged at somewhere between 70-80% if Im not mistaken... Aside from the first 10 years after I was infected, most of the time between about 1986 and the start oftreatment in Nov. 2014 was spent alcohol free. In addition, for the last 10 years, Ive been in the gym about 2 hrs/day 6 or 7 days a week. I suppose that hasnt hurt either.

>>The odds of maintaining a SVR after an undetected viral load at EOT+12 is actually <1%<<

Dont you mean > 99%? Or, to rephrase, dont you mean "The odds of NOT maintaining SVR after an undetected viral load at EOT + 12 is actually < 1%"?

>>Were you dealing with the painful effects of advanced disease and/or fibrosis, I'm almost certain you would be viewing this decision differently.<<

Absolutely, no question about that. And to be totally honest, the safest thing to do would be to not drink... But then, the safest thing to do would also be to not ride a motorcycle, or drive a fast car.. Or drive at all, for that matter... We all have to establish the level of risk in each of our lives that we are willing to take on.. Im not an adrenaline junky, so I generally try to minimize my risks, but of course, there are a few exceptions.

My next bloodwork will be the SVR24 test in July, but as weve determined, the odds of that not being UND are < 1%. Thanks again for your comments.

Brian1412 · Guru

I had a client recently that had a case of cheateu. Margaux 55..gave me a bottle but i will never drink. It myself. Wasnt a big drinker at all and i know i cant. I am very good with that

Gracie · Guru

It's a risk to do something that causes damage to an already damaged liver, and it can change and change quickly. I have had minimal elevations in my liver tests and a clean ultrasound in the past year and am now an F4. I personally know two people who successfully treated, one ten years ago, and both went back to drinking as though they never had it. I'm wasn't a heavy drinker but have chosen to be a non drinker as health and feeling good is too important to me to take a chance. I'm sure with minimal liver damage and SVR that a couple of drinks, the odds are in your favour that it won't cause any damage. Sometimes even the best odds don't pan out though. We will certainly find out as more and more people clear and some return to drinking if there is any repercussions as it will start to show.

Tig · Admin

You are lucky. To have the virus that many years and only be F/A 0-1 is almost unheard of, and I've been following this stuff for quite some time. If you're comfortable with your decision, I can either try to convince you of the potential problems or recommend a good micro brew. I can only present my own opinion and references to information like you provided in your links. There's a lot of conflicting data out there, so what people want to believe depends primarily on their own beliefs and interpretation. Were you dealing with the painful effects of advanced disease and/or fibrosis, I'm almost certain you would be viewing this decision differently.

The odds of maintaining a SVR after an undetected viral load at EOT+12 is actually >99%, provided there are no future issues that change the odds. I believe that is the best guess estimates following a few years of trial data number crunching. I try my best to remain an optimist regarding such figures. I also know that two years ago, when I was going through round 2 of an ugly 28 week Interferon triple protocol that about killed me, the best available SVR rates were 70-80%. Many here didn't succeed and didn't find out until 6-12 months after EOT. So who knows what the future will bring. I hope it brings continued improvements, but I feel everything we can do to shore up the rates of success is a wise decision.

Only when "they" have an easy (easier)100% success rate, 0% relapse possibility and the guarantee that alcohol use doesn't hold any risks to a former HCV patient, will I be able to comfortably say, go ahead and have that drink, but maybe just one. Right now, "they" haven't convinced me of that and that's my bit of pessimism poking through.

The new DAA protocols are excellent, no doubt about it, with better things on the way. I hope the access to treatment and cost of it are made readily available for anyone wanting it. Everything we can do to protect our successful defeat of the Dragon, seems a wise choice. I hope you live a long and healthy life and congratulate you for achieving the coveted SVR!

I invite you to introduce yourself in our New Members section. We've got a good group here and I'm sure they would like to welcome you to the forum. Good luck....

-- Edited by Tig56 on Wednesday 27th of May 2015 04:40:01 AM

boostm3 · Member

Hi Tig,

I had HCV likely from the early 70's until a few mos ago at which point I achieved SVR after 8 wks with Harvoni. Ive had 2 biopsies: the first was in '08 where I was scored stage 0 and grade 0, and again in mid 2013 where I scored Stage 0-1 and Grade 0-1. Believe me, I know how lucky I am. I drank nothing in the year leading up to treatment, and of course, nothing during treatment.. But now that I'm SVR with very minimal if any liver damage, I enjoy a couple of beers a week with friends. I know people lie about this, but Im telling the truth... Maybe 2 to 3 beers per week. If I had more liver damage, Id abstain. If I were an alcoholic, Id abstain.. And really, I know what a hot button issue this is, which is why we see so few threads about it in the forums... I know more folks would love to talk about it if it werent for the ire it causes among the membership.

Im fully aware that an Undetected result doesnt mean there is no virus.. However, the end point of treatment which is considered successful today is 12 wks SVR... At that point, we we can see in the attached link, odds of remaining virus free are over 99%. So whether its gone, disabled, or impotent, its as close to a 'cure' as we are going to see. Ill take those odds any day of the week! HCV is a blood borne disease... Alcohol cant give it to you. So it stands to reason that it cant cause relapse either. There is no evidence that alcohol can make absent, disabled, or impotent virus come life.

Predictability of SVR:

http://www.journal-of-hepatology.eu/article/S0168-8278(13)60850-8/pdf

A slightly more moderate take on the issue of alcohol after SVR:

http://www.healthline.com/health-news/if-im-cured-of-hepatitis-c-when-is-it-safe-to-drink-again-051415#1

Tig · Admin

Hi Boost,

Welcome to the forum. While the final determination on whether this can or cannot lead to a risk of relapse remains in the hands of researchers and those directly involved, such as physicians and medical professionals. The term cured of HCV is a misnomer in my opinion. SVR is the body's ability to sustain an undetected viral response. That doesn't mean you're rid of anything, it's just controlled by your immune system. As long as you maintain a healthy lifestyle and assuming you experience no immune system crisis, you have a very remote chance of relapse.

We all have some degree of liver damage as a result of this disease. Some have had it as long as 40 years! Research says that SVR halts further disease progression as a result of HCV. But fibrosis and liver damage don't go away overnight, so deciding to drink again won't do your liver any favors. It takes years for many of the problems to resolve, if then. Start hitting the booze and you risk dealing with fire and some odds that may not work in your favor. It's a choice each of us has to make.

I'm curious if you can provide a link to that information on Harvoni and unlimited alcohol use? I'm very interested in reviewing that. Thanks.

boostm3 · Member

mallani wrote:
The chances of relapse after SVR are pretty slim.
However, if you want to increase the chances, have a couple of drinks.
Good reminder Paul.

Where did you learn that alcohol after SVR increases chances for relapse? Im not saying that a sick liver cant be made sicker with alcohol.. But I dont see how a virus that is undetected at or after SVR12 can all of a sudden materialize, and begin replicating under the influence of alcohol. The odds of being virus free for perpetuity after 12 wks of Harvoni treatment are something like 99.5% regardless of alcohol consumption.

-- Edited by boostm3 on Tuesday 26th of May 2015 10:04:56 PM

-- Edited by boostm3 on Tuesday 26th of May 2015 10:05:54 PM

-- Edited by boostm3 on Tuesday 26th of May 2015 10:10:57 PM

Ro · Senior Member

Never really drank, but was told by my doctor that I could have a drink in the NEXT millennium....SVR and saving my liver is more important wink

basser · Senior Member

having got to svr but still left with ravages of hep c alcohol is a luxury i can do without.it would never be just one drink any way.

rblood · Member

I too quit drinking before I knew I had HepC. Been almost 30 years for me. Ive had Hep C for more than 40 years Im glad that I haven't drank all those years. I'm like Tig, I cant drink just one. One would just get me rollin!.....Roger

shadow10cats · Senior Member

Scruffy: exactly what u said - that's me.

Sure I would luv to have a glass of champagne to celebrate finally being able to finish a treatment and have it be successful - so far.

BUT: remember we are not ever truly "cured" only "undetectable"

I think the answer to whether or not to have a drink is going to be different for everyone. Some people were in pretty rough shape; maybe had a drinking problem, damaged livers, smoked, didn't exercise: started out in pretty bad shape overall. Others maybe didn't smoke or drink or had stopped many years prior. Weren't overweight, exercised, ate right etc. My liver values for example, were never ever bad. Always in the first 1/4 of the range never above 50% of the range. But even so, I am not comfortable having a drink, not yet anyway. Maybe after I am "undetectable" for 6 mos out I might have a glass should the opportunity arise. Say I'm at some sort of family event or party etc. But I will never ever drink to the point of getting sloshed again. I will never put my liver or my body thru that. I figure I have a 2nd chance here and am one of the lucky ones. There are many who didn't live to see this day and I just think it would be disrespectful to go back to our old bad habits.

Tig · Admin

For me, booze is analogous in nature to potato chips. I couldn't ever eat just one... If I were to start and relapsed, I'd be very unhappy that I had decided to give it another try. Aside from the hard earned SVR, remember that the previous level of fibrosis doesn't just get better overnight. It can take years to improve, if it does. True, disease progression comes to a halt with SVR, but those with advanced fibrosis still have issues to deal with. Drinking again won't allow any healing to begin and isn't that the reason we all decided to seek treatment in the first place? Food for thought!

Cheers!!

Gracie · Guru

And being at an increased risk of HCC, drinking alcohol would increase those odds more.

mallani · Guru

The chances of relapse after SVR are pretty slim.

However, if you want to increase the chances, have a couple of drinks.

Good reminder Paul.

Scruffy · Guru

Hi Paul

I haven't had a drink in maybe 20 years. I quit before I knew I had hep c although the thought was always in the back of my mind. Good article link. I don't have any want to drink and I don't think I ever will again. Guess I'm lucky.

Paul B · Senior Member

Thinking of a drink or two once you have achieved SVR ? You may find this article interesting !!

http://www.hepatitiscentral.com/news/having-a-beer-after-svr/

Hep C Discussion Forum

How safe is it to drink alcohol socially after being cured of hepatitis C infection?

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