“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 from 110 HBsAg and IgM HBc antibody–negative heavy drinkers (50 cirrhosis, 13 chronic active hepatitis, 25 fatty liver with or without mild to moderate fibrosis, alcoholic hepatitis or both and 22 healthy alcoholic subjects) with polymerase chain reaction. Results of hepatitis C virus polymerase chain reaction were compared with those obtained with two tests (second generation recombinant immunoblot assay and enzyme-linked 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 were well preserved for RNA extraction (42.5 cirrhosis, 83.3 chronic active hepatitis, 8 fatty liver and 0 healthy alcoholic subjects). Results obtained with second-generation recombinant immunoblot assay and enzyme-linked immunosorbent assay had a high degree of agreement with polymerase chain reaction as expected, the K indexes being 0.76 and 0.61, respectively. Nevertheless, five hepatitis C virus RNA-positive patients had negative recombinant immunoblot assay results, whereas all hepatitis C virus RNA-positive patients had positive or borderline enzyme-linked immunosorbent assay results. We conclude that, in Italian HBsAg-negative alcoholic patients, “inapparent” hepatitis B virus infection is rare. On the contrary, hepatitis C virus infection, as detected on hepatitis C virus polymerase chain reaction, is quite frequent, especially in patients who have cirrhosis and chronic active hepatitis. Second-generation enzyme-linked immunosorbent assay can be reliably used as initial test for the detection of hepatitis C virus infection in alcoholic patients; clearly positive results are very likely to correspond to viremia. Borderline results necessitate confirmation with polymerase chain reaction analysis. (Hepatology 1994;19:577–582).