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April 26, 1993

Hepatitis C Virus Antibody in Alcoholic Patients: Association With the Presence of Portal and/or Lobular Hepatitis

Arch Intern Med. 1993;153(8):965-969. doi:10.1001/archinte.1993.00410080031005

Objective:  To evaluate the relationship between hepatitis C viral infection and alcoholic liver disease.

Design:  Case-comparison study.

Setting:  Bronx (NY) Veterans Affairs Medical Center.

Participants:  Forty-seven consecutive alcoholic patients undergoing diagnostic liver biopsy.

Main Outcome Measures:  Serum was obtained at the time of liver biopsy and assayed for antibodies to hepatitis C virus using enzyme-linked immunosorbent assay, recombinant immunoblot assay, and hepatitis C virus neutralization methods.

Results:  Antibody to hepatitis C virus, as confirmed by the recombinant immunoblot assay, was strongly associated with the presence of portal and/or lobular inflammation (91% seropositivity) but was only present in 16% of patients without this histologic finding (P<.001). In patients without portal or lobular hepatitis, recombinant immunoblot assay seropositivity was seen in 27% of patients with cirrhosis and 20% of patients with alcoholic hepatitis and was absent in patients with steatosis and/or perivenular fibrosis. In the subgroup of alcoholic patients who were without known risk factors for hepatitis C virus infection (ie, no history of intravenous drug use or blood transfusions), antibody to hepatitis C virus was present in 78% of subjects with portal and/or lobular hepatitis but was absent in those with other types of alcoholic liver disease. Finally, anti—hepatitis C virus—seropositive patients had a significantly greater mean necroinflammatory score as compared with anti—hepatitis C virus— seronegative alcoholic patients (2.1 vs 1.2; P<.001). In contrast, there was no significant difference in the mean fibrosis score between the two groups.

Conclusions:  The presence of portal and/or lobular inflammation is strongly associated with antibodies to hepatitis C virus in alcoholic patients, even in the absence of known risk factors. This association indicates that hepatitis C virus is responsible, at least in part, for the portal and/or lobular hepatitis associated with alcoholic liver disease.(Arch Intern Med. 1993;153:965-969)