Efficacy and safety of a short term iron depletion therapy in hepatitis c virus- related compensated liver cirrhosis

الملخص EN

Background / Am : the association of chronic hepatitis C and hepatic iron overload is known since more than a decade.

Several studies have demonstrated that hepatic iron overload in patients with chronic hepatitis C is associate with a more liver pathology and a lower response to interferon therapy.

Therefore, iron reaction therapy via therapeutic phlebotomy was tried in patients with chronic hepatitis C and was found to improve the biochemical and histological outcomes, an improve the response to interferon therapy.

Recently, the potential role of (mild) increase of hepatic iron as a comorbid factor in mediating liver injury in chronic hepatitis C has been suggested and iron depletion therapy by phlebotomy has been found to produce beneficial results, regardless of the hepatic iron status.

Although patients with HCV-relate cirrhosis are more likely to have hepatic iron overload, the effect of iron reduction / depletion therapy on this group is not known.

The aim of the study is to evaluate the efficacy and safety of a short-term iron depletion therapy by phlebotomy in HCV^ elated compensate Liver Cirrhosis.

Patients & methods : A prospective controlled pilot study, which included Ault patients with evidence of HCV-related compensated cirrhosis, with elevate serum ALT levels and erythrocytosis.

Twenty five patients fulfilled the study criteria, 16 of them (Group A) were intended to have therapeutic phlebotomy till mild iron deficiency anemia is induced and maintained for a period of 6 months, an 9 patients not accept phlebotomy were used as a control group (Group B).

The efficacy of therapeutic phlebotomy was evaluated on the basis of biochemical parameters and its safety by the clinical picture and investigations.

Results : Twelve patients of group A (75 %) and 6 patients of group B (66.6 %) had baseline serum ferritin levels more than the upper limits of normal.

Three patients of group A were withdrawn from the study use to non-compliance.

The mean number of phlebotomy sessions needed to induce iron reaction in group A was 9 + 2 and to maintain it was 4 + 2.

Phlebotomy significantly reduced serum ALT levels from 83 + 8 to 42 + 6 U / L ; P = 0.01), with normalization of ALT levels in 10 / 13(67.9 %) of group A at the end of the study period.

These changes were not observed in the control group.

None of the patient's enveloped ascites or other signs of hepatic decompensating urging the period of the study.

Conclusion : the results of the present study demonstrate that a short term iron depletion therapy by phlebotomy is effective and safe in patients with HCV- relate compensate cirrhosis and erythrocytosis.