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Viral eradication restores normal iron status in chronic hepatitis C patients with abnormal iron studies
1Department of Internal Medicine, University of Iowa Roy J. and Lucille A. Carver College of Medicine, Iowa City, IA, United States.
Insights
Eradicating hepatitis C virus (HCV) infection with direct-acting antiviral agents (DAAs) significantly improves abnormal iron studies in most patients. This treatment normalizes iron levels, reducing concerns for hereditary hemochromatosis.
Area of Science:
- Hepatology
- Internal Medicine
- Clinical Biochemistry
Background:
- Abnormal iron studies affect over a third of patients with chronic hepatitis C virus (HCV) infection.
- These abnormalities are linked to accelerated liver fibrosis, increased hepatocellular carcinoma risk, and can mimic hereditary hemochromatosis.
- The impact of HCV eradication on these iron studies remains an important clinical question.
Purpose of the Study:
- To evaluate the effect of HCV eradication using direct-acting antiviral agents (DAAs) on abnormal serum iron studies.
- To assess the normalization of iron parameters after successful HCV treatment.
Main Methods:
- Retrospective analysis of 27 HCV-infected subjects with abnormal iron studies before and after DAA treatment.
- Comparison of serum iron, transferrin-iron saturation, and ferritin levels pre- and post-treatment.
Main Results:
- Successful HCV eradication led to significant decreases in serum iron, transferrin-iron saturation, and ferritin levels (p<0.01).
- Iron studies normalized in most patients (16/19 for iron/saturation, 14/18 for ferritin), including those with severe abnormalities.
- HCV elimination reduced ferritin levels even in those with normal baseline ferritin.
Conclusions:
- HCV eradication effectively restores normal iron status in the majority of patients with abnormal iron tests.
- Treatment with DAAs resolves iron abnormalities, including those resembling hemochromatosis.
- This highlights the importance of treating HCV for managing iron metabolism disorders.
Introduction And Objectives:
Abnormal serum iron studies are seen in a third or more of patients with chronic hepatitis C infection (HCV), where they have been linked to accelerated fibrosis progression and increased risk of hepatocellular carcinoma and sometimes lead to concern for coexisting hereditary hemochromatosis. The aim of this study was to assess the effect of HCV eradication in patients with abnormal serum iron studies prior to treatment with direct-acting antiviral agents (DAAs).
Patients:
HCV-infected subjects with iron studies obtained before and after successful treatment with DAAs were identified (n=27). All had one or more abnormal iron test before treatment.
Results:
Following HCV eradication, serum iron, transferrin-iron saturation and ferritin levels decreased significantly (pre- versus post-treatment, p<0.01 for each). Serum iron and/or transferrin-iron saturations normalized in 16/19 subjects and raised ferritin levels returned to the normal range in 14/18 subjects, including several with pretreatment transferrin-iron saturation >90% and/or serum ferritin >1000ng/mL. Elimination of HCV infection was associated with a significant reduction in post-treatment ferritin levels even among subjects whose ferritin levels were within normal limits at baseline. Risk factors for other conditions associated with abnormal iron status were present in the few cases in which iron studies failed to normalize following DAA treatment.
Conclusions:
Eradication of HCV infection restores normal iron status in most patients with abnormal iron tests, including those whose baseline parameters are suggestive of hemochromatosis.
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