Iron depletion and response to interferon in chronic hepatitis C
Carlo, C.; Daniela, P.; Giancarlo, C.
Hepato-Gastroenterology 50(53): 1467-1471
2003
ISSN/ISBN: 0172-6390 PMID: 14571765 Document Number: 565885
Background/Aims: Chronic viral hepatitis is associated with elevated serum iron indexes, and iron accumulation in the liver may contribute to liver injury and fibrosis due to hepatitis as well as increased risk of developing hepatocellular carcinoma. We studied the effect of iron depletion on the response to subsequent interferon therapy in chronic hepatitis C. Methodology: A population of 83 patients affected by chronic hepatitis C who had not previously undergone any specific therapy and who had laboratory confirmation of iron overload (serum ferritin >400ng/mL in the males and >300ng/mL in the females) was divided into two homogeneous groups. The 43 patients in Group A underwent phlebotomy (300mL every 10-15 days for an average total of 8 sessions) until their serum ferritin levels were <100ng/mL. The 40 patients in Group B were treated with interferon without prior iron depletion. Results: In Group A, iron depletion alone induced a highly significant (p<0.01) reduction of alanin aminotransferase serum values: from 165 U/L (range: 60-370 U/L). Seventy-six patients completed therapy and follow-up: a complete and sustained response was obtained in 12/39 cases in Group A and in 6/37 cases in group B (p<0.05). Conclusions: Iron depletion carried out in patients with chronic hepatitis C who have elevated serum ferritin values induces a significant reduction in necro-inflammatory activity (notable decrease in average alanine aminotransferase values) and improves their response to subsequent treatment with interferon, although it does not modify the viral load.