The natural history of liver disease in former drug users

Three hundred and twenty drug-free former narcotic addicts were studied with regard to persistence of abnormalities of liver function and morphology, and their relation to hepatitis B infection. Hepatitis B antibody was present in 52.4%, while HB(s) antigen was detected in only 6%. Transaminase abnormalities, initially present in 39%, were found in 22 % six months after cessation of drug abuse. Abnormalities tended to persist thereafter, although there was some continued return to normal levels. Liver biopsy findings of chronic persistent and aggressive hepatitis correlated with persistence of HB(s) antigenemia and transaminase elevation. Follow-up liver biopsies in seven subjects showed decreased inflammatory reaction in five. None showed progressive liver disease. We conclude that: (1) 15 to 20 % of former narcotics addicts have chronic persistent hepatitis or chronic aggressive hapatitis after cessation of drug abuse for six months or more; (2) serologic evidence of exposure to HB(s) antigen is frequent, and rapidly develops after the start of needle use; (3) although histologic and chemical abnormalities usually persist, progression did not occur, and some individuals demonstrated spontaneous improvement.