Porphyria cutanea tarda, hepatitis C virus and selected symptoms of cholestasis

The influence of hepatitis C virus (HCV) infection on the development of porphyria cutanea tarda (PCT) was recently detected, but the status of trace elements in etiology of the diseases is relatively poorly recognized. Individually observed symptoms of cholestasis do not seem to be related to the above conditions.

A group of 22 PCT patients (37-73 years old, mean 54.9 years), including 10 cases (45.5%) of serum HCV-RNA positive, as evaluated by automatic Cobas AmplicorTM Hepatitis C ver. 2.0 assay (Roche Diagnostics), was assessed. None of the patients have recently abused alcohol. Serum levels of copper and bilirubin, activity of gammaglutamyltranspeptidase (GGTP) and alkaline phosphatase (ALP) were measured in all patients.

We have found statistically significant differences between both mean serum activity of GGTP (145.9 U/l vs. 58.3 U/l, p = 0.004) and mean serum copper levels (131.9 mg/dl vs. 79 mg/dl, p = 0.003) in patients infected with HCV compared to the other PCT patients, respectively. Mean serum ALP activity was also higher, but the difference was not of statistical importance (106.9 U/l vs. 90.9 U/l, p = 0.24); mean serum bilirubin concentration was significantly lower in HCV-infected patients (0.55 mg/dl vs. 0.85 mg/dl, respectively, p = 0.035).

In our group of PCT patients we have noticed a higher serum copper level and higher activity of both GGTP and alkaline phosphatase, but lower level of serum bilirubin in patients infected with HCV as compared with those not infected. This observation does not confirm suggestions concerning the role of HCV in promotion of cholestatic liver disease in PCT patients. The influence of HCV infection on the metabolism of copper and GGTP activity is connected rather with the inflammatory lesions in the liver of PCT patients infected with HCV. Bilirubin metabolism in PCT patients requires further studies for its elucidation.