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Consumption of alcohol after treatment of acute Hepatitis C
Apr 6, 2010

Dear Barbara,

I am a 37 year old HIV+ male. Not a drug user.

- Jan 2004: diagnosed HIV+. CD4 consistently 500-600 with no need for HAART.

- Dec 2008: contracted Hepatitis C type 1a (confirmed by testing old blood samples) from sexual transmission. This was diagnosed in Feb 2009 after ALT rose to 370, and I immediately abstained from alcohol.

- July 2009: started 48 weeks of Pegasys and Copegus. HCV Viral load was 2.5 million at start of treatment, but I was undetetectable at week 4.

- April 2010: Still undetectable with 7 weeks of treatment left. CD4 around 200, and still on HAART. Side effects from Interferon/Ribavirin have been severe but i've stuck with the full dosage, and not missed any doses.

It would appear that HIV speeds up progression to fibrosis in HIV/HCV co-infected patients, yet all of the research I have found seems to relate to people who have had both viruses for longer than 6 months. I can't seem to find anything with particular reference to acute HCV cases.

What do you think would be my chances of SVR? What would be your opinion of any liver damage I may have sustained in my circumstances? In particular, would you say i would be safe to drink alcohol after treatment, or would you advise waiting to confirm SVR? I am not a recreational drug user nor a heavy drinker- maybe 6-8 beers per week.

I do seem to be part of an increasing number of people with HIV and acute HCV though, so I hope your answer to this question might prove useful to more people than myself.

Many thanks in advance.

Response from Dr. McGovern

I am very concerned about the rising incidence of acute HCV in HIV infected persons, so I am glad that you raise this as an issue. Acute HCV among MSM is associated with traumatic sex and also with other STDs, like syphilis.

I am very happy that you started therapy soon after infection. With a rapid response, I think your chances of a sustained response are very high..

There is a paper to suggest that rapid fibrosis progression occurs after acute HCV in HIV infected patients, but there was also data at the HIV conference in February suggesting the importance of long-term follow-up of such patients. This poster suggested that short term follow may overestimate rates of fibrosis progression. These data have not yet been published yet.

Regardless, I think it is critically important to get early treatment for acute HCV infection since the cure rates are so much higher - whether you have underlying HIV or not.

Alcohol in moderation of 1 to 2 drinks a day will probably not be an issue for you - but would not drink now while you are going for the cure....Best regards for your health.

confused re: hep b test results
Really worried in South Africa.

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