Urinary porphyrin excretion in hepatitis C infection

A high prevalence of hepatitis C virus infection in porphyria cutanea tarda in some populations suggests a close link between viral hepatitis and alte ration of porphyrin metabolism. Moreover, there is evidence of a role of po rphyrinopathies in hepatocarcinogenesis. The aim of our study was to obtain data on the prevalence and patterns of heme metabolism alterations in pati ents with chronic hepatitis C virus infection. Urinary porphyrin excretion was prospectively studied in 100 consecutive outpatients with chronic hepat itis C infection without signs of photosensitivity, using an ion-pair high performance liquid chromatography method. Increased total porphyrin excreti on was found in 41 patients, with predominant excretion of coproporphyrins (whole study group: mean 146 mu g/g creatinine, interquartile range 76-186; normal <150), in 10 patients excretion exceeded 300 mu g/g creatinine. In the majority of all patients studied (75/100) an increased ratio of the rel atively hydrophobic coproporphyrin isomer I to isomer III was found. In jus t one case, urinary porphyrin pattern characteristic for chronic hepatic po rphyria was present (uroporphyrin > coproporphyrin, heptacarboxyporphyrin I II increased) but the total porphyrin excretion was only slightly elevated in this case. In the whole group, total urinary porphyrin excretion correla ted well with serum bilirubin and was inversely correlated with albumin and thrombin time. In conclusion, secondary coproporphyrinuria occurs frequent ly in heptatitis C infection, whereas in Germany, preclinical porphyria cut anea tarda seems to be rare in these patients.