HCV and Iron Excess: The Interaction and how to Handle it

Mild to moderate hepatic iron overload is frequently present in patients with chronic hepatitis C. There is a growing body of literature suggesting that excess hepatic iron may contribute to more rapid progression of liver disease and potentially to development of hepatocellular carcinoma. However, there remains a paucity of data demonstrating the benefit of iron depletion as a treatment for chronic hepatitis C. Hepatic iron content in chronic hepatitis does not predict the response rate to interferon and ribavirin combination therapy in either treatment-naive or treatment-experienced patients. However, the presence of HFE haemochromatosis mutations does increase the risk of advanced hepatic fibrosis especially among C282Y homozygotes. Therefore, measurement of serum iron stores and appropriate use of HFE genotyping is indicated as part of the routine evaluation in patients with chronic hepatitis C.