Some reasons why you should not drink too much

StephenW

http://www.aidsmeds.com/articles/hepatitis_alcohol_treatment_1667_21832.shtml

January 30, 2012

Alcohol Treatment Boosts Hep C Cure Rates Among Drinkers
         

  People who drink—even heavily—can successfully undergo treatment for hepatitis C virus (HCV) if they’re provided with individualized, multidisciplinary care that also addresses their alcohol use, according to a study published in the February 2012 issue of Journal of Hepatology.  

Caroline Le Lan, MD, and her colleagues in Brittany, France, treated 73 alcohol-dependent patients for both hepatitis C and addiction, between September 2002 and February 2008. Their treatment outcomes were compared to a matched group of non-drinkers. Although overall cure rates were similar (48 percent versus 49 percent for non-drinkers), people who drank excessively during HCV treatment—defined as 21 or more drinks per week for men, 14 or more drinks per week for women, or at least four drinks at a time, at least twice—were less likely to be cured than those who drank less or were abstinent.  

Excessive alcohol consumption—50 grams (3.5 glasses of wine) or more a day—is known to worsen liver damage from hepatitis C. Drinking also increases hepatitis C viral load, and it may make adherence to HCV treatment difficult. For these reasons, the American Association for the Study of Liver Diseases (AASLD) recommends that HCV treatment decisions for people actively using alcohol be determined on a case-by-case basis, with an emphasis on patient participation in an alcohol support program.  

According to the AASLD’s HCV Practice Guidelines, “[I]t seems reasonable to recommend either the complete suspension of alcohol intake while on treatment or restricting its use to an occasional drink during the course of the treatment.”

There is very little information on HCV treatment outcomes among moderate or excessive drinkers. “Doctors are reluctant to treat alcoholic patients because they fear that these patients may experience more side effects and have poor adherence and that heavy alcohol consumption may worsen antiviral treatment outcomes,” said Lan and her colleagues, noting that it may not be possible for every alcohol-dependent patient to reduce, or stop, alcohol consumption, either before or during HCV treatment.

Before starting treatment, study participants were seen by a hepatologist, counseled about risks and benefits of HCV treatment, and evaluated by an addiction specialist who provided individualized counseling. Although study participants were encouraged to reduce or stop alcohol consumption, they were not disqualified if they continued to drink. Excessive drinking was reported by 62 percent of participants when they started HCV treatment; their alcohol consumption ranged from 30 to 98 drinks per week, and the majority had a history of injection drug use. Only 34 percent had been abstinent for less than three months.

Pegylated interferon and ribavirin were administered for six to 12 months, according to HCV genotype and response to treatment. Most were first-time treatment takers. Thirty-four percent had HCV genotype 3, and 42 percent had a low hepatitis C viral load—both of which are associated with higher likelihood of achieving a sustained virological response (SVR), or viral cure. In contrast, 34 percent had serious liver damage, which reduces the odds of being cured.

Overall, 65 percent of abstinent patients were cured, compared with 52 percent of moderate drinkers and 33 percent of heavy drinkers. People with a low pre-treatment HCV viral load were more likely to be cured, as were study participants with a history of severe drug addiction. “This indicates that difficulties with drugs, such as pursuing injections despite substitution treatment, are not a reason to exclude patients from treatment,” Lan and her colleagues wrote.

A total of six participants discontinued treatment, and another six missed some of their study visits. Treatment adherence was associated with family and social status, and duration of abstinence from alcohol before treatment.





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StephenW

2012年1月30日

酒精治疗在饮酒提高HVC治愈率

的人喝，甚至重可以成功地接受治疗丙型肝炎病毒（HCV），如果他们提供个性化，多学科的照顾，还涉及其使用酒精，肝脏病杂志2012年2月发表的一项研究。

卡罗琳的Le局域网，医学博士，和她的同事，法国，布列塔尼治疗73丙型肝炎和成瘾的酒精依赖患者，2002年9月和2008年2月之间，。他们的治疗结果进行了比较，不饮酒者的匹配组。虽然整体的治愈率分别为类似（非饮酒者的48％与49％），过度喝在丙型肝炎病毒治疗的人定义为每周21个或更多的饮料，男性，14个或更多的妇女每周饮料，或至少有四个一次饮料，至少有两次是不太可能比那些谁喝少或戒断被治愈。

过量饮酒50克（3.5的酒杯）或一天被称为恶化肝脏丙型肝炎饮用水的损害，也增加了丙型肝炎病毒载量，它可能使坚持丙型肝炎的治疗带来困难。由于这些原因，美国肝病（AASLD）研究协会建议，积极使用酒精与酒精支持计划的病人参与的重点，逐案的基础上确定的人丙型肝炎病毒治疗的决定。

据肝病学会的丙型肝炎病毒的实践指南“] T似乎是合理的建议，要么全部停止酒精的摄入量，而在治疗或限制其使用，在治疗过程中偶尔喝。”

很少有中度或过量饮酒对丙型肝炎的治疗效果之间的信息。兰和她的同事说：“医生不愿意治疗酒精的病人，因为他们担心，这些患者可能会遇到更多的副作用，依从性差和酗酒可能恶化的抗病毒治疗效果，并指出，它可能不是每一个可能的酒精依赖患者，以减少或停止，饮酒前或在丙型肝炎治疗。

治疗开始前，参与研究的人看到一个肝病，HCV治疗的风险和好处，劝告和瘾专家提供个性化的辅导评估。虽然鼓励减少或停止酒精消费研究参与者，他们并没有被取消资格，如果他们继续喝。过量饮酒，62％的受访者，当他们开始HCV治疗，他们的饮酒量为每周30至98饮料，多数人注射毒品的历史。只有34％已戒断不少于三个月。

聚乙二醇干扰素和利巴韦林6至12个月的管理，根据丙型肝炎病毒基因型和治疗反应。大多是第一次治疗普查员。百分之三十四个丙型肝炎病毒基因型3，和42％低肝炎彗星病毒载量，这两者是实现持续的病毒学应答（SVR），或病毒治愈的可能性较高。相比之下，34％有严重肝功能损害，从而降低了治愈的可能性。

总体而言，65％戒断患者全部治愈，与适度饮酒者的52％和33％的酗酒者。低治疗前丙型肝炎病毒载量的人更可能被治愈，严重的吸毒史研究的参与者。 “这表明尽管替代治疗，是不是一个理由来排除治疗的患者与药物，如推行注射困难，兰和她的同事们写道。”

共有六个参与者停止治疗，另有6个错过了一些考察。坚持治疗是与家庭和社会地位，和禁欲时间从治疗前的酒精。

作者“，说：”吊诡的是，酒精的患者，有严重的肝脏疾病进展的最​​有潜力的，从治疗没有任何公布的证据排除。有结合治疗丙型肝炎和酒精依赖的是一个意想不到的好处：三分之一的患者，其中一半是重度饮酒者，HCV治疗期间停止饮用和保持戒断之后。兰的研究小组得出结论，“治疗酒精患者是可行的，并导致病毒在其中一些贫穷和持久的酒精停止。”