In this protocol we will evaluate the patterns and severity of liver disease in alcoholics who are infected with hepatitis C virus (HCV). Comparison groups include nonalcoholics (abstainers and nonabusive consumers of alcohol) infected with HCV and alcoholics who are not infected with HCV. Measures of liver disease include the histologic activity index (Knodell Scoring) for chronic active hepatitis, as well as noninvasive and functional studies, including transaminase fluctuations over time and changes in blood bile salt levels in response to a nutritional stimulus. Additional studies include measurement of urinary 24 hour cortisol excretion and CSF levels of CRH and ACTH to determine whether hypothalamic-pituitary-adrenal axis activation in alcoholics has a negative impact on liver disease. The response of lymphocytes (obtained from the peripheral blood and liver) to both nonspecific and specific (i.e., HCV protein and/or peptide) antigens will also be studied during alcohol withdrawal and at various times of abstinence from alcohol. Preliminary results show that liver biopsy specimens obtained from 15 asymptomatic alcoholics with HCV have revealed various degrees of chronic active hepatitis which does not appear to differ significantly from changes found in (-) HCV alcoholics (n equals 5).
