Hi Dr McGowan,

I have said it before and will say it again, the information that yourself, Ben, Nelson and Mark provide is invaluable in providing reassurance, guidance and support to those like myself with the virus and those doing their best not to join the club. Quite often the advice elsewhere online is not clear, often contradictory and rarely up-to-date, so thanks again. Okay, about 5 months ago when I was going through a severe depression I was drinking heavily for about 2 months (I mean heavy!), so my question is will this have affected my long term response to HAART? I am still undetectable. My second question is related to the first to some extent; how long does it take for a problem to show up in terms of viral rebound after an incident or incidents? For example, if my alcoholic binges had reduced drug absorption, would this have resulted in viral rebound around the same time or some months (or even years later)? The same question goes for missed doses. The anxiety is that past mistakes get somehow archived and viral rebound occurs later therefore a current undetectable result doesn't reflect the damage done and that will eventually manifest later. Finally, I still like to go out and socialise and sometimes this results in a heavy drinking session. Does acute episodes like this affect the performance of ARV's? Okay, cheers and take care, Michael.

Hello Michael Thank you for your questions and compliments. Heavy drinking can have two effects. Acutely, one could get alcoholic hepatitis or acute inflammation of the liver. If the acute inflammation does not progress to liver failure, there is usually a recovery of liver function. The chronic impact to excessive alcohol intake is cirhossis of the liver and eventual liver failure that usually requires a liver transplant. The liver dysfunction seen in cirhossis can have an impact on the metabolism or breakdown of medications that use the liver for this purpose. The metabolic impact may increase the toxicities seen with certain HIV drugs. Excessive alcoholic intake may cause nausea, vomiting and inflammation of the lininig of the stomach (or gastritis) and this may make tolerating an HIV regimen more difficult. The long term impact of missed doses of antiretrovirals depends on whether it leads to viral rebound or growth. A virus that is allowed to replicate or grow in the presence of drugs at suboptimal doses increases the chance of viral mutations that could confer drug resistance over time.