Nurse knows a few highballs help life’s medicine go down. But the cocktails may not mix, especially if yours contains…
Ritonavir (Norvir) and indinavir (Crixivan): These protease inhibitors share a pathway with alcohol through the liver (processor of all substances), so your pills might poop out due to poor absorption. Crix with liquor also ups your risk for kidney stones • Abacavir (Ziagen): Booze boosts blood levels of this nuke, making side effects nastier • ddI (Videx): Steady drinking can raise the risk of pancreatitis • And excess alcohol can increase insulin resistance, leading to diabetes — already a threat to HAARTy folk. Gulp.
Up in Smoke
Ahhh, that very first cigarette of the day tastes sooooo fine. Nurse has been there, smoked that. But there are some very big buts about butts:
Can you say emphysema and tuberculosis, cancer of the lung, throat, stomach and pancreas, and heart disease and osteoporosis (loss of bone)? • Cigs inflate the risk that human papilloma virus (HPV) will morph into cervical or anal cancer • Smoking accelerates hepatitis C, since the toxins are processed in the (overworked) liver • Cigarettes can house the germ that causes MAC (mycobacterium avium complex)—and send it straight to your lungs • Butts promote HIV-related blights such as hairy leukoplakia (non- removable, white, corrugated or “hairy” tongue lesions) • Pneumocystis carinii pneumonia (PCP) hits twice as many positive smokers as those who don’t puff—and hits them faster. Pass the ashtray.
I’m nursing a hangover from hell after a night out with the boys. And when I drink, I like to have a few smokes. How bad we talkin’ here? —Head Case
Booze and her sinister sister, tobacco: My dears, where would the human race be without these so-sublime substances? Nursie herself would still be muddling about in muck and mire, rubbing sticks together instead of purring, “Be a dear—mix Mummy a double.” Western civilization was conceived and gestated in alcohol (with smokes added for ambience). “This is my blood,” said Jesus, passing the hooch at the Last Supper. Indeed, the Bible is soaked with sloshed prophets and patriarchs. Empires rise and fall on the liquor and tobacco trades, and through it all, humans hit the sauce and cigs for solace and celebration.
Despite (or because of) ol’ Mr. Virus and his baggage, many HIVers belly up to the bar with the best. Alcohol abuse is at least twice as common for HIVers as for others (see “When’s Last Call?” below). And, you puffers, if your diagnosis didn’t send you to Smokenders, more’s the pity.
Nurse needs mention: Alcohol is generally toxic to every bodily organ (the liver in particular). Chronic lushing can damage your ability to heal from illness or injury. And booze will make lunchmeat of your liver if you’ve got hepatitis. Need she add that firewater makes you forget to take your meds?
“I’m hep-free,” you cry, “and reports say a dram a day can keep heart attacks at bay.” Yes, but swallow: A study looked at some 350 HIVers with a history of substance abuse and “moderate or heavy” alcohol intake (two tipples or more every day). Those on HIV meds had higher viral loads and fewer CD4s than HAART-hefting teetotalers—but this wasn’t true of those who swallowed alcoholic but not HIV cocktails. Both HIV meds and liquor tax your liver, and too much drink can overwhelm the poor dear before the meds get there.
“All this talk about booze—I need a ciggy!” you snarl. Though Nurse sees pros and cons in the bottle, she can’t find a single kind word for the evil weed. Oh, how about cancer? A British study found lung cancer about eight times more prevalent in pozzies than in neggies. Other research shows smoking increases HIVers’ risk for a slew of nasties (see “Heavenly & Hazardous”). Why do HIVers who fear facial wasting not quake in dread of the wrinkles cigs plaster on their pusses? And who wants to kiss an ashtray? So, whereas Nurse lives large by the harm-reduction credo, her advice to smokers is: Butt out! Chew Nicorette, slap on a Nicoderm patch, ask Doc for Zyban (bupropion HCL), join a support group, get hypnotized, call Smokenders (1.800.828.HELP)…merciful heavens, just don’t inhale.
When’s Last Call?
A little is good. a lot is not. HIV docs on how much is too much:
Tipplers toasted last year’s news that people who down two drinks a day live longer than those who don’t booze at all. What’s the rule for HIVers? “There’s no specific rule,” says Cal Cohen, MD, of New England’s Community Research Initiative. “So we rely on the general—two drinks a day unless you’ve got hepatitis or a history of addiction” (which scads of HIVers do).
Barbara Johnston, MD, of New York City’s St. Vincent’s Hospital, adds, “Remember that HAART and alcohol both stress your liver. And due to weight and metabolism, women tolerate less than men.” Johnston says docs use “CAGE” to screen for overuse: A yes to two of the four questions suggests a problem:
- Have you ever felt you should Cut down?
- Do you get Annoyed if others mention your drinking?
- Have you ever felt Guilty about your drinking?
- Ever need an Eye-opener (an early-morning drink)?
“I suggest stopping for two weeks,” New York City’s Howard Grossman, MD, says. “If patients feel better, they may decide to drink less. If they can’t stop for two weeks, the problem may be larger.”
The docs all call the bouncer on binge drinking and on any booze at all if you’ve got hep B or C.For more info: Moderation Management at www.moderation.org or 212.871.0974.