CLINICOPATHOLOGICAL ASSESSMENT OF HEPATITIS-C VIRUS-INFECTION IN PARENTERAL DRUG-ABUSERS

To determine the severity of hepatic histological lesions in anti-HCV positive parenteral drug abusers and to correlate it with the level of ALT activity and HCV RNA determined by polymerase chain reaction (PCR ). Methods: Twenty-nine of the 62 anti-HCV-positive parenteral drug ab users who consecutively entered a Rehabilitation Center of Athens cons ented to liver biopsy and were prospectively and thoroughly followed u p for a mean of 12.9 (range 6-33) months, Anti-HCV was detected by a s econd-generation enzyme immunoassay and confirmed by a second-generati on recombinant inmunoblot assay, Serum samples were tested for HCV RNA by nested PCR with primers from the highly conserved 5' untranslated region of the HCV genome, Results: Liver biopsy revealed lesions compa tible with chronic hepatitis in 26 (89.6%) and a normal liver in three (10.4%) of the 29 patients. In particular, 11 (37.9%) had minimal and 15 (57.1%) had mild chronic hepatitis; fibrosis was absent or mild in all cases, Histological grade and stage were significantly milder in patients with persistently normal ALT activity than in those with incr eased ALT activity, However, chronic hepatitis was observed in five (6 2.5%) of the eight patients with normal ALT levels, The presence of se rum HCV RNA was not significantly correlated with the severity of hist ological lesions, HCV RNA was detected in 16 (57.1%) of the 28 cases t ested, In particular, HCV RNA was detected in one (33.3%) of the three cases with normal liver and in three (37.5%) of the eight patients wi th normal ALT levels, Conclusions: Liver biopsy appears to be the meth od of choice for the accurate evaluation of anti-HCV positive parenter al drug abusers, irrespective of ALT activity and presence of serum HC V RNA, Chronic hepatitis is observed in the majority and the state of ''healthy'' carrier of HCV in the minority of this epidemiological set ting.