Chronic alcoholism in patients with chronic hepatitis C alcoholics with anti-HCV and liver disease also have HCV RNA (65% to 94%) detectable in serum; indeed, this marker appears to cause more severe and rapidly progressive liver is detected in some alcoholic patients with liver disease who disease leading more frequently to cirrhosis of the liver and are anti-HCV negative. hepatocellular carcinoma. The primary risk factor for acquiring hepatitis C among alcoholics is injection drug use. How-ASSOCIATION OF ALCOHOL USE AND SEVERITY ever, the epidemiology is not well defined, and other sources OF HEPATITIS C of spread must be important. Alcohol intake in excess of Alcoholic patients with anti-HCV confirmed by immu-10 g/d has been associated with increased serum hepatitis C noblot are also likely to have HCV RNA detectable in serum, viral RNA and aminotransferase levels, the mechanism of indicating active viral infection. The presence of HCV RNA which is poorly understood. The histological picture of hepatiusually is associated with some degree of necroinflammatory tis C in patients with chronic alcoholism is typically indistinchanges with or without fibrosis in the liver regardless of guishable from chronic hepatitis C in nonalcoholic patients. serum alanine aminotransferase (ALT) levels. Furthermore, Interferon therapy is less effective among alcoholic than nonalcoholic patients with anti-HCV have, on average, more sealcoholic patients, even after a period of abstinence. Patients vere liver disease than antibody-negative patients. In a large with chronic hepatitis C should restrict their alcohol intake Veterans Administration study, confirmed anti-HCV positivto less than 10 g/d, and if cirrhosis is present or interferon ity in serum correlated positively and significantly with the therapy is planned, abstinence from alcohol should be encourpresence of cirrhosis, cellular unrest, periportal inflammation, aged. Future research efforts should focus on the epidemioland piecemeal necrosis on liver biopsy in alcoholic subjects. 6 ogy and pathogenesis of combined chronic hepatitis C and In contrast, antibody to hepatitis B core antigen did not correalcoholism. (HEPATOLOGY 1997;26(Suppl 1):39S-42S.) late with any of these histological features. In a study of 144 alcoholic patients from Spain, the prevalence of anti-HCV was 20% in patients with alcoholic fibrosteatosis, 21% in those The alcoholic patient is subject to the spectrum of hepatowith alcoholic hepatitis, and 43% in patients with alcoholic biliary disorders that afflict the nonalcoholic patient, and in cirrhosis as compared with 2.2% in alcoholic patients without some cases may be predisposed to other forms of liver injury liver disease. 7 Histological features, with the exception of sibecause of specific socioeconomic, epidemiological, or metanusoidal cellularity, were comparable in alcoholic patients bolic risk factors. After the introduction of serological tests with and without anti-HCV. A study from Japan by Nishifor antibody to hepatitis C virus (anti-HCV), it has become guchi et al. 8 used both immunoblotting for anti-HCV and apparent that hepatitis C is common among alcoholics with HCV RNA determinations to assess HCV infection among 80 liver disease, and the interaction of alcohol and hepatitis C alcoholic patients with liver disease. Patients with cirrhosis virus (HCV) is associated with more severe clinical disease. and HCV RNA had higher ALT levels than comparable patients without HCV RNA. Patients with HCV RNA had higher
PREVALENCE OF ANTIBODIES TO HCV
histological indices of disease activity using the histology ac-
IN ALCOHOLIC PATIENTS
Abbreviations: anti-HCV, antibody to hepatitis C virus; HCV, hepatitis C virus;
HCV RNA -positive alcoholic patients, lymphoid follicles ALT, alanine aminotransferase.
were found in 35% and lymphoid aggregates in 93% of pa-From the Division of Hepatology, Center for Liver Diseases, University of Miami tients, both features being typical of chronic hepatitis C.