Liver iron accumulation in chronic hepatitis C patients without HFE mutations: relationships with histological damage, viral load and genotype and alpha-glutathione S-transferase levels

Background Host and viral factors have been suggested as possible causative factors for the presence of liver iron accumulation in chronic hepatitis C . However, there is no agreement regarding the influence of liver iron accu mulation on the biochemical and histological severity of chronic hepatitis C. Moreover, data concerning the relationships between both viral load and genotype and liver iron accumulation are scanty. Aims To evaluate the biochemical, histological and virological assessment o f a group of chronic hepatitis C patients without risk factors for iron ove rload, on the basis of the presence, degree and distribution of liver iron accumulation. Methods Fifty-three chronic hepatitis C patients (34 men, 19 women; age 44 +/- 11 years) with no risk factors for liver iron accumulation and showing no HFE mutations were chosen from a broader cohort of chronic hepatitis C p atients. The presence, degree and distribution of liver iron accumulation w ere assessed using Deugnier's score. Relationships between the presence of liver iron accumulation and grading and staging were carried out separately . Hepatitis C virus RNA serum levels and viral genotype were compared in pa tients with or without liver iron accumulation. Alpha glutathione S-transfe rase serum levels were assessed in all patients. Results Overall, liver iron accumulation was mild and was present in 19 pat ients (36%). It was associated with male gender (P = 0.0358), and was refle cted by high serum iron levels (P = 0.001) and high ferritin levels (P < 0. 0001). Hepatitis C virus RNA levels and genotype were not associated with t he presence of liver iron accumulation. In multivariate analysis, ferritin was the only variable significantly associated with liver iron accumulation (P < 0.0001). Grading was higher in patients with liver iron accumulation regardless of the site of iron deposition. Fibrosis was present in all pati ents with iron overload; these patients were more frequently cirrhotic. Mor eover, patients with mesenchymal or mixed deposition had higher staging tha n patients with hepatocytic or no iron deposition. This feature was reflect ed by higher alpha -glutathione S-transferase levels. Conclusions Liver iron accumulation is mild in chronic hepatitis C patients without HFE mutations and is mainly reflected by serum ferritin levels. Vi ral characteristics do not seem to play a role in iron deposition. Liver ir on accumulation is associated with higher grading, advanced fibrosis and ci rrhosis. Moreover, higher staging is associated with mesenchymal or mixed i ron deposition. In these patients, higher a-glutathione S-transferase level s seem to reflect more complex damage. (C) 2001 Lippincott Williams & Wilki ns.