ABNORMAL SERUM PORPHYRIN LEVELS IN PATIENTS WITH THE ACQUIRED-IMMUNODEFICIENCY-SYNDROME WITH OR WITHOUT HEPATITIS-C VIRUS-INFECTION

Objective: To define the contributions of human immunodeficiency virus (HIV) and hepatitis C virus infections to the development of porphyri a cutanea tarda.Design: Analysis of serum porphyrin levels in a cohort of 167 subjects. Serum samples were divided into 4 groups correspondi ng to the status of HIV and hepatitis C virus infections: positive-pos itive, positive-negative, negative-positive, and negative-negative. Se tting: Serum samples positive for HIV were obtained from the serum ban k of an acquired immunodeficiency syndrome-HIV research center, and HI V-negative samples were obtained hom a regional blood center. Main Out come Measures: Spectrofluorometric measurement of serum porphyrin leve ls. Results: The median values of porphyrin were 2.31 nmol/L (interqua rtile range [difference between the 25th and 75th percentiles] : 4.55) in the positive-positive group, 1.99 mmol/L (interquartile range: 1.6 3) in the positive-negative group, 1.31 nmol/L (interquartile range; 1 .58) in the negative-positive group, and 1.14 nmol/L (interquartile ra nge: 0.92) in the negative-negative group. The fluorescence emission s pectra of samples with elevated porphyrin levels were identical with t hat reported for porphyria cutanea tarda. Elevated porphyrin levels we re significantly associated with HIV infection (P<.001) and were obser ved in patients with an elevated level of alanine aminotransferase (P= .03). Infection with hepatitis C virus was also associated with an ele vation in porphyrin levels, although the increase was not statisticall y significant (r=.16). Porphyrin levels in patients positive for HIV w ere not correlated with serum urea nitrogen or creatinine levels. None of the patients had symptomatic porphyria cutanea tarda. Conclusions: Factors associated with increased serum porphyrin levels included HIV infection. elevated alanine aminotransiferase levels, and, to a lesse r extent, hepatitis C virus infection. These findings suggest that pat ients with the above risk factors are potentially predisposed to the d evelopment of symptomatic porphyria cutanea tarda on further exposure to hepato-toxic agents.