HCV and HGV infection, iron overload and liver disease in multitransfused patients with thalassaemia and persistently normal or abnormal transaminase levels.
Prevalence and influence on liver disease of HCV and HGV infections, and HCV genotypes were studied in 28 HCV-Ab positive multitransfused thalassaemia patients with persistently normal ALT levels (group A) matched by sex and age with 28 patients with increased ALT levels (group B). Laboratory and virologic tests (all patients), liver biopsy (28 patients) and LIC by SQUID (30 patients) were performed. In group A, HCV-RNA was positive in 39%, genotype 2a was detected in 91%. In Group B, HCV-RNA was positive in 89%, prevalence of genotype 1b and 2a was 52% and 48% respectively; compared with group A, they had significantly increased values of gammaGT, AF, BA, TP, IgG, IgA, LIC (group B: 2,142 -/+ 1,524 microg/g liver; group A: 1,084 -/+ 610 microg/g liver). Overall prevalence of HGV-RNA was low (12.5%) and not significantly different between groups. Liver biopsies revealed no cirrhosis and severe fibrosis was found in 3 HCV viremic patients in group B. In 14 viremic patients examined both for LIC and liver histology, mild fibrosis was observed in 71%, in which iron overload was below 5 times the normal value. In conclusion, in patients with normal ALT levels, active HCV infection must be excluded by evaluation of HCV-RNA. Liver biopsy is indicated in HCV viremic patients, independent of ALT levels; in non-viremic patients, increased ALT levels may be due to iron overload and LIC measurement is indicated. Our data emphasise the crucial role of chelation therapy to maintain low LIC levels in order to prevent progression of fibrosis to cirrhosis in patients with HCV chronic hepatitis.
Gamberini
Maria Rita
MR
Department of Reproduction and Growth, Paediatric and Adolescent Unit, S. Anna Hospital, Ferrara, Italy. mr.gamberini@libero.it
Francesconi
Raffaella
R
Fortini
Monica
M
Cavazzini
Luigi
L
Lari
Federico
F
Scapoli
Chiara
C
Ballardini
Giorgio
G
De Sanctis
Vincenzo
V
Bianchi
Francesco B
FB
D000328:Adult; D000410:Alanine Transaminase / Q000097:blood*; D001803:Blood Transfusion; D005260:Female; D018178:Flaviviridae Infections / Q000150:complications* / Q000453:epidemiology / Q000821:virology; D029407:GB virus C / Q000235:genetics / Q000254:growth & development; D016174:Hepacivirus / Q000235:genetics / Q000254:growth & development; D006526:Hepatitis C / Q000150:complications* / Q000453:epidemiology / Q000821:virology; D006801:Humans; D019190:Iron Overload / Q000150:complications* / Q000378:metabolism / Q000821:virology; D008107:Liver Diseases / Q000378:metabolism / Q000821:virology; D008297:Male; D012367:RNA, Viral / Q000097:blood; D017086:beta-Thalassemia / Q000201:enzymology / Q000378:metabolism* / Q000628:therapy / Q000821:virology*
D012367:RNA, Viral; D000410:Alanine Transaminase