Hepatic Iron, Liver Steatosis and HCV Genotypes in Patients with Chronic Hepatitis C

In the medical literature, hepatic iron often has been cited as a significant cofactor in the outcome of hepatitis C. However, the mechanisms that lead to hepatic iron deposits (HIDs) in patients with hepatitis C infection are not fully understood.

In the current study, researchers evaluated HIDs in the liver biopsies of a consecutive series of 242 HCV patients with well-compensated liver disease.

Results

	Serum ferritin was elevated in 20.7% and transferrin saturation in 19.0%, while 38.8% had stainable HIDs indicating that serum markers of systemic iron overload have low sensitivity in predicting HIDs in hepatitis C.
	A cut-off value of serum ferritin (350 microgram/L in females and 450 microgram/L in males) had good negative predictive value in excluding presence of mild-moderate HIDs (grade II-III).
	Hepatic iron deposits correlated with serum ferritin and albumin.
	HIDs were more frequent in HCV genotype 3 patients than in other genotypes (P = 0.027) while raised serum iron indices were more frequent in non-HCV-3 genotypes (P = 0.02).
	Furthermore, advanced fibrosis (F3-F4 by METAVIR) was more frequent in non-HCV-3 genotypes (P = 0.04).
	In HCV-3 cases there was a close association between HIDs and severe (grade II-III) steatosis (P < 0.00001).

The study authors conclude, "These results indicate that in well-compensated chronic hepatitis C patients, hepatic iron deposits are strongly associated with HCV-3 and viral-induced hepatic steatosis, while in the presence of other genotypes they might merely reflect a more advanced stage of liver disease and/or a systemic iron overload."

"Serum ferritin could identify a subgroup of patients in which the need of venesection could be excluded without liver biopsy."

03/14/06

Reference
G Sebastiani and others. Journal of Viral Hepatitis 13(3): 199-205. February 2006.