INAPPARENT HEPATITIS-B VIRUS-INFECTION AND HEPATITIS-C VIRUS-REPLICATION IN ALCOHOLIC SUBJECTS WITH AND WITHOUT LIVER-DISEASE

We evaluated hepatitis B virus DNA and hepatitis C virus RNA in sera f rom 110 HBsAg and IgM HBc antibody-negative heavy drinkers (50 cirrhos is, 13 chronic active hepatitis, 25 fatty liver with or without mild t o moderate fibrosis, alcoholic hepatitis or both and 22 healthy alcoho lic subjects) with polymerase chain reaction. Results of hepatitis C v irus polymerase chain reaction were compared with those obtained with two tests (second generation recombinant immunoblot assay and enzyme-l inked immunosorbent assay) used to detect hepatitis C virus antibodies . Hepatitis B virus DNA was found in three (2.7%) patients. Hepatitis C virus RNA was detected in 29 (29.8%) of the 97 subjects whose sera w ere well preserved for RNA extraction (42.5% cirrhosis, 83.3% chronic active hepatitis, 8% fatty liver and 0% healthy alcoholic subjects). R esults obtained with second-generation recombinant immunoblot assay an d enzyme-linked immunosorbent assay had a high degree of agreement wit h polymerase chain reaction as expected, the kappa indexes being 0.76 and 0.61, respectively. Nevertheless, five hepatitis C virus RNA-posit ive patients had negative recombinant immunoblot assay results, wherea s all hepatitis C virus RNA-positive patients had positive or borderli ne enzyme-linked immunosorbent assay results. We conclude that, in Ita lian HBsAg-negative alcoholic patients, ''inapparent'' hepatitis B vir us infection is rare. On the contrary, hepatitis C virus infection, as detected on hepatitis C virus polymerase chain reaction, is quite fre quent, especially in patients who have cirrhosis and chronic active he patitis. Second-generation enzyme-linked immunosorbent assay can be re liably used as initial test for the detection of hepatitis C virus inf ection in alcoholic patients; clearly positive results are very likely to correspond to viremia. Borderline results necessitate confirmation with polymerase chain reaction analysis.