[The effect of iron depletion on the response to interferon treatment in patients with chronic hepatitis C. Pilot study].
It has been reported that increase in serum ferritin levels and/or in hepatic iron content is associated with a poor response to interferon treatment in patients with chronic hepatitis C (CH-C).


OBJECTIVE
To determinate whether iron depletion by phlebotomy (PB) increases the response to interferon therapy in chronic hepatitis C.


METHODS
We have evaluated 12 patients with CH-C (genotype 1b = 11, 1a = 1), increased ALT levels, positive serum VHC-RNA and increased serum ferritin levels (> 220 ng/ml), including 8 previously non responders to interferon therapy and 4 naive subjects. Phlebotomies were performed weekly (mean number per patient: 6, range: 5-12) until serum ferritin levels were < 100 ng/ml, followed by interferon treatment (3MU thrice weekly for 3-12 months depending on the response).


RESULTS
Multiple regression analysis showed that serum ferritin levels were not related to serum ALT levels (p = 0.18) or viral load (p = 0.06). Serum ALT levels decreased significantly post-PB (58 U/l, range: 35-141 U/l) as compared to pretreatment levels (164 U/l, range: 51-216 U/l, p < 0.006) and normalized in two subjects. HCV-RNA was positive in one of the latter and negative in the other. Eleven of the twelve patients did not respond to interferon after three months of therapy (increased serum ALT levels in 10 subjects and positive HCV RNA in 11). One additional patient, who had not been treated previously with interferon and had low pretreatment viral load, had a sustained response after 12 months of interferon therapy. Viral load did not decreased either with PB or following interferon treatment. By contrast, serum ferritin levels did not increase with interferon treatment or during the 6 month follow-up period.


CONCLUSIONS
Decreasing serum ferritin levels by phlebotomies does not increase HCV erradication rate after interferon treatment. Sustained response to interferon therapy is an infrequent event and is more dependent on viral factors (viral load and genotype).
Ortiz
V
V
Servicio de Medicina Digestiva, Hospital Universitario La Fe, Valencia.
Olaso
V
V
López Viedma
B
B
Córdoba
J
J
Molina
J M
JM
Lainez
B
B
Pastor
M
M
Berenguer
J
J
D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use*; D005260:Female; D005293:Ferritins / Q000097:blood*; D016174:Hepacivirus / Q000235:genetics; D019698:Hepatitis C, Chronic / Q000097:blood / Q000188:drug therapy*; D006801:Humans; D007372:Interferons / Q000627:therapeutic use*; D007501:Iron / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D018962:Phlebotomy; D010865:Pilot Projects; D011446:Prospective Studies; D012367:RNA, Viral / Q000097:blood; D000637:Transaminases / Q000097:blood
D000998:Antiviral Agents; D012367:RNA, Viral; D005293:Ferritins; D007372:Interferons; D007501:Iron; D000637:Transaminases