Porphyria cutanea tarda and hepatitis C virus: a case-control study and meta-analysis of the literature.
BACKGROUND
Porphyria cutanea tarda (PCT) and hepatitis C virus (HCV) infection have been associated in several reports with the prevalence of HCV exhibiting considerable regional variation. However, most reports were confounded by selection bias and a regional prevalence of HCV in the populations studied. In the United States, only a few cases of this association have been reported to date.


OBJECTIVE
We concluded a study to evaluate the association between PCT and HCV in a US population. We used a case-control study design to control the systemic error that may occur during a selecting process or sampling procedure.


METHODS
We reviewed the medical records of Wishard Memorial Hospital, a county hospital serving metropolitan Indianapolis, Indiana, to perform a retrospective case-control study of 26 patients with PCT (as case) against 149,756 regional volunteer blood donors (as control-1) and 51 patients receiving methotrexate for psoriasis (as control-2). HCV antibody titers and other liver abnormalities were our main outcome measures. We then performed a weighted meta-analysis of 17 reports that had at least 17 patients in their study populations.


RESULTS
Sixteen (94%) of 17 PCT patients tested for HCV were antibody positive. Among blood donors, only 255 or 0.17% were HCV antibody positive (P < 10(-5), two-sided chi-square test). Of 5 psoriasis patients tested for HCV, none were HCV antibody positive (P = .0002, two-sided Fisher's exact test). For geographic comparison, meta-analysis of the literature demonstrated a varying regional prevalence of HCV in PCT patients as follows: Northern Europe 17%, Australia/New Zealand 20%, and Southern Europe 65%.


CONCLUSIONS
Although a marked geographic variation was found in the worldwide prevalence of HCV in PCT patients, a very large percentage of US patients with PCT had HCV infection. Our results emphasize the need for clinicians to actively look for HCV in patients with PCT.
Chuang
T Y
TY
Department of Dermatology, Indiana University School of Medicine, Roudebush Veterans Affairs Medical Center, Indianapolis, USA.
Brashear
R
R
Lewis
C
C
D001315:Australia / Q000453:epidemiology; D001782:Blood Donors; D016022:Case-Control Studies; D005060:Europe / Q000453:epidemiology; D005260:Female; D006526:Hepatitis C / Q000150:complications* / Q000453:epidemiology; D018937:Hepatitis C Antibodies / Q000032:analysis; D006801:Humans; D008297:Male; D009520:New Zealand / Q000453:epidemiology; D017119:Porphyria Cutanea Tarda / Q000150:complications* / Q000453:epidemiology; D015995:Prevalence; D012189:Retrospective Studies; D016036:Seroepidemiologic Studies; D014481:United States / Q000453:epidemiology
D018937:Hepatitis C Antibodies