LIVER IRON CONCENTRATION IN CHRONIC VIRAL-HEPATITIS - A STUDY OF 98 PATIENTS

Objective: To compare the liver iron concentration (LIC) of Italian pa tients with chronic hepatitis B and C with those of controls, to evalu ate increased LIC frequency in patients and to investigate the influen ce of the haemochromatosis gene in the development of liver iron overl oad. Design and setting: Prospective controlled trial in two northern Italian hospitals. Patients: Ninety-eight patients (61 men and 37 wome n), 85 with chronic hepatitis C and 13 with chronic hepatitis B, and 3 8 control individuals (20 men and 18 women). Methods: Atomic absorptio n spectrophotometry was used to determine LIC; standard lymphocytotoxi city test was used for HLA typing in patients with increased LIC; and family studies were performed for patients with major iron overload. R esults: Mean LIC was significantly higher in both patient groups than in the controls. Thirty-five patients (36%) had an increased LIC. Twen ty-six of these patients had a minor iron overload, whereas nine (9.2% ) had a major overload. HLA-A3 antigen was present in five out of the 26 and in four out of the nine patients, respectively. Family studies revealed two siblings HLA-identical to their own proband without evide nce of iron overload and chronic hepatitis. Conclusion: Increased LIC is frequent in Italian patients with chronic hepatitis. The mechanism by which the hepatitis virus promotes liver iron accumulation is not k nown, but it can favour the development of major iron overload in some cases. HLA-A3 antigen prevalence and family studies suggest that in t hese cases a single haemochromatosis gene probably coexists with the v iral infection. LIC should be determined as part of the screening eval uation in patients with suspected chronic hepatitis B or C.