Living With Coinfection
Some of these lifestyle changes can also reduce the risk for hepatitis C progression, especially cutting down or avoiding alcohol. General things like stopping smoking, eating and resting properly, cutting down stress, and taking exercise are important for everyone.
Probably the most important aspect of dealing with any medical condition includes having the time and support to become better informed about choices that affect your health.
Another common experience is to look at aspects of your life in order to reduce stress and improve both quality of life and general health. Some of these lifestyle changes can also reduce the risk for HCV progression, especially cutting down or avoiding alcohol. General things like stopping smoking, eating and resting properly, cutting down stress, and taking exercise are important for everyone.
Heavy drinking is known to be harmful to the liver. Alcohol intake in amounts over 50 grams per day for men and over 30 grams per day for women accelerates HCV progression. Fifty grams is equivalent to four or five glasses of wine, beer or mixed drinks. Binge drinking is more harmful for your liver than regular drinking.
Alcohol harms the liver by increasing both inflammation and scarring. Generally, the less you drink, the better for your liver, since no one has determined what amount of alcohol is safe for people with chronic HCV. Drinking less -- or not at all -- may be more important than treating HCV.
Alcohol increases hepatitis C viral load, which makes HCV treatment less effective. This may be why studies of treatment with interferon (since replaced by a combination of pegylated interferon and ribavirin) reported that HCV treatment was not very effective for people who drink alcohol.
A few more recent studies have not reported much difference in HCV treatment outcomes among drinkers vs. non-drinkers. Nonetheless, many doctors will not treat people who consume alcohol.
Heavy drinkers are not eligible for HCV treatment in the UK.
Alcohol is mainly broken down by the liver, but during this process bi-products are produced that damage the liver more than the alcohol itself.
Prolonged inflammation from long-term alcohol use results in the over production of molecules called "free radicals" that can destroy healthy liver tissue and subsequently impair liver function.
Alcohol can also disrupt the production of antioxidants, which defend the body against free radical damage. The combination of over-production of free radicals and loss of antioxidants can lead to liver damage.
Women may be more vulnerable to the damaging effect of alcohol than men.
Drinking less -- or not at all -- can be very difficult. Some people cut down or quit on their own, others find that support groups, counselling, and/or pharmacotherapy works best for them.
The following suggestions may help, whether you decide to drink less or quit drinking altogether.
If you decide to cut down
If you decide to stop completely
Some are more toxic than others, but all will stress your liver to some extent.
They are also likely to contain impurities and unspecified ingredients that are also toxic and difficult to assess. In general, injecting drugs is more dangerous as this bypasses the filtering system of the stomach.
If you are injecting drugs, using sterile equipment (syringe, cooker, filter, water, tie and measuring syringe) will protect you from reinfection with hepatitis C and other infections.
You may want to consider reducing your intake of recreational drugs, or stopping. If so, there are places where you can get help.
Smoking is not good for your health. There is some weak data to suggest that smoking may encourage the progression of hepatitis C, but most people in the studies also drank alcohol.
Some Primary Care Trusts run "quit smoking" programmes that incorporate group therapy.
Stopping smoking is not easy, and probably not recommended during HCV treatment, if you feel it gives you support.
While quitting may be an important goal in the long-term, it may not be your most important short-term priority.
Liver abnormalities are more common in people who are overweight. This is usually defined as having a Body Mass Index (BMI) that is over 25.
These may include fatty deposits found in the liver and fatty inflammation or fatty liver. This is more common in people who have diabetes. Fat in the liver can cause it to become enlarged and can lead to raised liver enzymes.
People who are overweight and who have a fatty liver, and who subsequently reduce their weight, are likely to have an improvement in fat-related liver abnormalities. Loosing weight increases the chance of a better response to hepatitis C treatment.
If you do find it hard to maintain lower weight, ask to see a dietician for specialist advice.
A healthy and balanced diet is important for general good health. With advanced liver disease, avoiding or reducing certain foods may become more important.
This includes avoiding or reducing:
Herbal remedies have been used for centuries to treat liver disease, but they cannot cure hepatitis C. So far, no clinical trials have demonstrated that herbal remedies are effective against hepatitis C (HCV), but many people use these nonetheless.
Some people use them because conventional treatment has not worked for them, or because of concerns about side effects of HCV therapy.
Many other combinations of herbs are being sold to treat HCV or benefit the liver. Unfortunately, these products are unregulated, and differ in purity and strength.
Some herbs actually be harmful to the liver, and others may interact with HIV drugs and other medications.
It is important to discuss the use of any herbs or supplements with your doctor.
There is some research on the therapeutic use and drug interactions of herbs:
Traditional Chinese medicine
This article was provided by HIV i-Base. It is a part of the publication Hepatitis C for People Living With HIV. Visit HIV i-Base's website to find out more about their activities, publications and services.