CLINICAL-SIGNIFICANCE OF CONCOMITANT HEPATITIS-C INFECTION IN PATIENTS WITH ALCOHOLIC LIVER-DISEASE

The significance of antibodies to hepatitis C virus in patients with c hronic alcoholic liver disease is unclear. Prior studies have utilized the first-generation enzyme-linked immunosorbent assay, which is limi ted by problems with sensitivity and specificity. Hepatitis C virus in fection in 137 patients with biopsy-proven alcoholic liver disease was assessed with second-generation hepatitis C virus antibody assays and reverse transcription-polymerase chain reaction for detection of hepa titis C virus RNA in the serum. The patients were categorized into thr ee groups according to results of serological testing. Discriminant-fu nction analysis was used to determine which factors (risk, biochemical and histological) could best differentiate the three groups. Thirty-t hree patients were reactive on second-generation enzyme-linked immunos orbent assay/second-generation recombinant immunoblot assay and RNA po sitive (group 1). Twelve were reactive on second-generation enzyme-lin ked immunosorbent assay/second-generation recombinant immunoblot assay but RNA negative (group 2). Eighty-six were nonreactive on second-gen eration enzyme-linked immunosorbent assay, and six were reactive on se cond-generation enzyme-linked immunosorbent assay but negative on seco nd-generation recombinant immunoblot assay and negative for hepatitis C virus RNA (group 3). Seventy-six percent of patients in group 1 and 58% in group 2 had parenteral risk factors, compared with only 1% in g roup 3 (p < 0.00001). The mean ALT level was higher in group 1 patient s (p < 0.05). The mean histologic activity index was significantly hig her in group 1 (p = 0.0007). Periportal and bridging necrosis and port al inflammation were significantly increased in group 1 (p = 0.0004 an d p = 0.002, respectively). We found no significant difference in intr alobular degeneration and focal necrosis or fibrosis among the three g roups. The histological and biochemical features of groups 2 and 3 wer e similar. Most patients with alcoholic liver disease with concomitant hepatitis C infection have an identifiable parenteral risk factor. Pa tients with viremia have histological evidence of chronic hepatitis su perimposed on alcoholic liver disease. The histological features of he patitis C virus antibody-reactive patients without viremia resemble th ose of patients without serological evidence of hepatitis C virus infe ction.