HEPATITIS-C VIRUS-ANTIBODIES AND LIVER-DISEASE IN PATIENTS WITH PORPHYRIA-CUTANEA-TARDA

The recent identification of the hepatitis C virus and development of assays to detect antibodies to hepatitis C virus has allowed assessmen t of the prevalence of hepatitis C virus infection in patients with a variety of liver and other diseases. The aim of this study was to inve stigate the prevalence of hepatitis C virus antibodies and severity of liver injury in patients with porphyria cutanea tarda. Sixty-two pati ents were studied. Serum samples were analyzed for liver function para meters and markers of hepatitis B virus infection. Frozen serum sample s from 34 patients with porphyria cutanea tarda, obtained when patient s were seen at the hospital for the first time, were analyzed for hepa titis C virus antibodies with enzyme-linked immunosorbent assays (firs t- and second-generation) and a recombinant immunoblot assay. As contr ols, serum samples from 19,788 blood donors, 40 patients with alcoholi c liver disease and 138 hospitalized patients without liver disease we re also tested for hepatitis C virus antibodies. Liver biopsy was perf ormed in 42 porphyria cutanea tarda patients. Specimens were evaluated for steatosis, siderosis, fibrosis, severity of inflammation and the presence of cirrhosis. In addition, the degree of necroinflammatory ch ange and fibrosis were quantitated with the histologic activity index described by Knodell et al. The prevalence of hepatitis C virus antibo dies in patients with porphyria cutanea tarda (62%) was higher than th at in blood donors (0.79%), patients with alcoholic liver disease (17. 5%) or hospitalized patients without liver disease (5.8%). Among porph yria cutanea tarda patients, those who were positive for hepatitis C v irus antibodies by recombinant immunoblot assay had mean serum ALT lev els (114 IU/L) significantly higher (p < 0.05) than those in patients negative by recombinant immunoblot assay (mean = 54 IU/L). Of 42 patie nts who underwent liver biopsies, 20 had been tested for hepatitis C v irus antibodies. Of these patients, 15 were recombinant immunoblot ass ay positive (11 had chronic hepatitis or cirrhosis and 4 had steatosid erosis) and 5 were recombinant immunoblot assay negative (all had stea tosiderosis). In conclusion, these results strongly suggest that hepat itis C virus infection may contribute to liver damage in patients with porphyria cutanea tarda.