The Covert Liver Disease of Drug Addicts

Summary: Twenty young narcotic addicts who had been using drugs intravenously for at least two years were examined for the presence of liver disease. Eleven (55%) had abnormal liver function tests, and 19 (95%) had abnormal liver biopsies. Fourteen showed the changes of chronic persistent hepatitis. The remaining five showed in addition greatly expanded portal tracts with dense lymphoid aggregates and poorly formed histiocytic granulomas. Foreign material was identified in five biopsies. No patient had HB Ag in the serum, but four had detectable levels of HB Ab. It is concluded that the liver lesion is associated with the repeated intravenous injection of contaminated drug preparations, but no single causal agent, infective or chemical, has been clearly identified. Despite little biopsy evidence of progression, florid changes persist long after drug taking has stopped, so that a benign prognosis cannot be assured.