The characteristics of alcoholics with HCV infection: histopathologic comparison with alcoholics without HCV infection and chronic type C hepatitis.

Out of 71 patients admitted to the National Kurihama Hospital and a related hospital for alcoholics or hepatic dysfunction, we studied the histopathology of alcoholics with HCV infection. Liver biopsies were divided into three groups depending on whether or not the patient was an alcoholic and anti-HCV antibody positive. The three groups were: (1) 30 HCV-antibody negative alcoholics, (2) 17 HCV-Ab positive alcoholics, and (3) 24 HCV-Ab positive non-alcoholics. Alcoholics developed specific hepatic fibrosis with a solid appearance, and the HCV-Ab negative alcoholics had relatively less lymphocytic infiltration. In contrast, patients with type C virus developed fibrosis with a loose appearance with more lymphocytic infiltrates including lymphfollicular accumulation. HCV-Ab positive alcoholics showed mixed features such as more fibrosis and less piecemeal necrosis and lymphocytic infiltration, especially in follicle formation, than HCV-Ab positive non-alcoholics. Changes of hepatocytes, such as hydropic swelling, fatty change and acidophilic body, increased in severity in the alcoholics compared with the non-alcoholics with viral hepatitis. These findings suggest that the combined exposure to both alcohol and HCV enhances hepatocellular damage, but suppresses inflammatory reactions such as lymphocyte infiltration and follicle formation seen in type C hepatitis.