The Role of Iron in Hepatitis C Infection |
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Authors: | Tusar K Desai Jared Bortman Rasm Al-Sibae Herbert Bonkovsky |
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Institution: | 1. Department of Internal Medicine, William Beaumont Hospital, 3535 W 13 Mile Road, Royal Oak, MI, USA 2. Carolinas Medical Center, Charlotte, NC, USA
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Abstract: | Iron overload of varying degrees is common among patients with chronic hepatitis C. The clinical significance of this iron
overload is uncertain. Studies that have evaluated the effect of hepatic iron stores on the response to anti-viral treatment
or on the natural history of chronic hepatitis C have found variable results depending on the technique used to measure hepatic
iron stores and the degree of iron overload present among the study population. We have tried to comprehensively analyze the
literature regarding the clinical interaction between iron overload and the natural history of chronic hepatitis C. The one
clear relationship that emerges is that pre treatment serum ferritin inversely correlates with the odds of achieving sustained
virological(SVR) response after combination interferon ribavirin treatment. We have also reviewed the limited literature that
reports the effect of therapeutic phlebotomy to reverse iron overload among patients with chronic hepatitis C. A small meta-analysis
of 6 prospective randomized trials and a subsequent seventh trial do suggest that phlebotomy to induce iron depletion enhances
the likelihood of achieving (SVR) after anti-viral therapy. However, these studies are primarily in patients receiving interferon
monotherapy, which is of course now obsolete. Finally, a few small studies suggest that therapeutic phlebotomy to induce iron
depletion reduces liver transaminase levels and may improve histology, and perhaps even reduce the risk of hepato-cellular
carcinoma. Prospective randomized controlled trials of phlebotomy among patients with advanced hepatitis C and iron overload
are needed. |
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