Objective: To compare the liver iron concentration (LIC) of Italian patients with chronic hepatitis B and C with those of controls, to evaluate increased LIC frequency in patients and to investigate the influence of the haemochromatosis gene in the development of liver iron overload.
Design and setting: Prospective controlled trial in two northern Italian hospitals.
Patients: Ninety-eight patients (61 men and 37 women), 85 with chronic hepatitis C and 13 with chronic hepatitis B, and 38 control individuals (20 men and 18 women).
Methods: Atomic absorption spectrophotometry was used to determine LIC; standard lymphocytotoxicity test was used for HLA typing in patients with increased LIC; and family studies were performed for patients with major iron overload.
Results: Mean LIC was significantly higher in both patient groups than in the controls. Thirty-five patients (36%) had an increased LIC. Twenty-six of these patients had a minor iron overload, whereas nine (9.2%) had a major overload. HLA-A3 antigen was present in five out of the 26 and in four out of the nine patients, respectively. Family studies revealed two siblings HLA-identical to their own proband without evidence of iron overload and chronic hepatitis.
Conclusion: Increased LIC is frequent in Italian patients with chronic hepatitis. The mechanism by which the hepatitis virus promotes liver iron accumulation is not known, but it can favour the development of major iron overload in some cases. HLA-A3 antigen prevalence and family studies suggest that in these cases a single haemochromatosis gene probably coexists with the viral infection. LIC should be determined as part of the screening evaluation in patients with suspected chronic hepatitis B or C.