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Clinical significance of concomitant hepatitis C infection in patients with alcoholic liver disease
Author(s) -
Fong TseLing,
Kanel Gary C.,
Conrad Andrew,
Valinluck Boontar,
Charboneau Francine,
Adkins Rodney H.
Publication year - 1994
Publication title -
hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.488
H-Index - 361
eISSN - 1527-3350
pISSN - 0270-9139
DOI - 10.1002/hep.1840190303
Subject(s) - concomitant , alcoholic liver disease , alcoholic hepatitis , medicine , gastroenterology , liver disease , clinical significance , disease , hepatitis , hepatitis c , virology , cirrhosis
The significance of antibodies to hepatitis C virus in patients with chronic alcoholic liver disease is unclear. Prior studies have utilized the first‐generation enzyme‐linked immunosorbent assay, which is limited by problems with sensitivity and specificity. Hepatitis C virus infection 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 hepatitis C virus RNA in the serum. The patients were categorized into three groups according to results of serological testing. Discriminant‐function analysis was used to determine which factors (risk, biochemical and histological) could best differentiate the three groups. Thirty‐three patients were reactive on secondgeneration enzyme‐linked immunosorbent assay/second‐generation recombinant immunoblot assay and RNA positive (group 1). Twelve were reactive on second‐generation enzyme‐linked immunosorbent assay/second‐generation recombinant immunoblot assay but RNA negative (group 2). Eighty‐six were nonreactive on second‐generation enzyme‐linked immunosorbent assay, and six were reactive on second‐generation enzyme‐linked immunosorbent assay but negative on second‐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 group 3 (p < 0.00001). The mean ALT level was higher in group 1 patients (p < 0.05). The mean histologic activity index was significantly higher in group 1 (p = 0.0007). Periportal and bridging necrosis and portal inflammation were significantly increased in group 1 (p = 0.0004 and p = 0.002, respectively). We found no significant difference in intralobular degeneration and focal necrosis or fibrosis among the three groups. The histological and biochemical features of groups 2 and 3 were similar. Most patients with alcoholic liver disease with concomitant hepatitis C infection have an identifiable parenteral risk factor. Patients with viremia have histological evidence of chronic hepatitis superimposed on alcoholic liver disease. The histological features of hepatitis C virus antibody‐reactive patients without viremia resemble those of patients without serological evidence of hepatitis C virus infection. (Hepatology 1994;19:554–557).