The Histological Assessment of Hepatitis B Viral Activity in Patients with Heavy Alcohol Consumption

Objectives: Taiwan has a high prevalence of hepatitis B viral (HBV) infection with rising alcoholic liver disease. We investigated the histological assessment of viral hepatitis B activity in patients with concomitant HBV infection and alcoholism. Methods: 229 patients (33 with concomitant heavy alcoholism and HBV infection, 114 with HBV infection alone, and 82 with heavy alcoholism alone) were enrolled between 2009 and 2012 at Cathy General hospital and E-Da hospital. Results: Patients with concomitant alcoholism and HBV infection are male predominant and younger. 97.4% and 91.4% patients have detectable HBV DNA in patients with HBV infection without or with alcoholism, respectively. Patients with concomitant HBV infection and alcoholism have much piecemeal necrosis, confluent necrosis, focal necrosis, portal inflammation, necroinflammatory grading, and cirrhosis with Ishak stage 5-6 fibrosis. Moreover, patients with concomitant HBV infection and alcoholism also have much pericelluar fibrosis, sclerosing hyaline necrosis, non-alcoholic fatty liver disease (NAFLD) ballooning, NAFLD activity score (NAS) and NAFLD Stage 4 fibrosis (P<0.001). However, patients with alcoholism alone have much more steatosis than those with HBV infection with and without alcoholism. Conclusions: Patients having concomitant alcoholism and HBV infection develop the histological features of both alcoholic liver disease and viral hepatitis B. The assessment of hepatitis B viral activity in alcoholic liver disease depends on detectable viral load and histological features of viral hepatitis B in patients with concomitant HBV infection and alcoholism.