Abstract
The evolution of ferritin levels in hepatitis C virus (HCV)-infected patients with sustained virological responses (SVRs) following various therapy regimens remains elusive. An 8-year prospective cohort study of 1194 HCV-infected patients [interferon-based therapy (n = 620), direct-acting antiviral agent (DAA) therapy (n = 355)] was conducted. At baseline, sex, alanine aminotransferase (ALT), triglycerides, homeostatic model assessment of insulin resistance (HOMA-IR), estimated glomerular filtration rate (eGFR), hemoglobin, iron/total iron-binding capacity (Fe/TIBC) and IFNL3-rs12979860 genotypes were associated with ferritin levels. At 24 weeks posttherapy, ALT, triglycerides, total cholesterol, eGFR, Fe/TIBC and the therapy regimen were associated with ferritin levels in SVR patients. Among interferon-treated patients, ferritin levels increased at 24 weeks posttherapy, regardless of SVR, and 24-week posttherapy ferritin levels were higher in non-SVR patients (n = 111) than in SVR patients (n = 509); ferritin levels began decreasing at 3 years posttherapy and were lower than pretherapy levels since 4 years posttherapy in SVR patients. Among DAA-treated SVR patients (n = 350), ferritin levels decreased and remained stable since 24 weeks posttherapy. ALT, triglycerides, eGFR, and Fe/TIBC were HCV-unrelated factors associated with ferritin levels; sex, HOMA-IR, total cholesterol, hemoglobin and IFNL3-rs12979860 genotype were HCV-related factors associated with ferritin levels. In interferon-treated SVR patients, the increased trend of posttherapy ferritin levels was not reversed until 4 years posttherapy. In DAA-treated SVR patients, ferritin levels decreased since 24 weeks posttherapy.
Highlights
The anti-Hepatitis C virus (HCV) therapeutic regimens and responses affect the serum ferritin levels remain elusive but are crucial for the prognosis of Chronic HCV infection (CHC) patients, as ferritin is essential for iron homeostasis and is involved in a wide range of physiologic and pathologic processes[20], and the ferritin levels in CHC patients with sustained virological response (SVR) might serve as a prognostic marker
The most compelling results of the current study are as follows: (1) At baseline, sex, ALT, TG, homeostatic model assessment of insulin resistance (HOMA-IR), estimated glomerular filtration rate (eGFR), hemoglobin, Fe/TIBC and IFNL3-rs12979860 genotype were associated with ferritin levels of CHC patients
(2) At 24 weeks posttherapy, ALT, TG, total cholesterol (TC) eGFR, Fe/TIBC, and therapy regimen were associated with ferritin levels of SVR patients
Summary
The anti-HCV therapeutic regimens and responses affect the serum ferritin levels remain elusive but are crucial for the prognosis of CHC patients, as ferritin is essential for iron homeostasis and is involved in a wide range of physiologic and pathologic processes[20], and the ferritin levels in CHC patients with sustained virological response (SVR) might serve as a prognostic marker. Comparing the pre- and posttreatment variables in SVR patients has provided an excellent opportunity to eliminate the interference caused by individual b ias[21] when reviewing the impact of HCV on alterations in ferritin levels. We sought to fill the aforementioned knowledge gaps by conducting an 8-year prospective cohort study analyzing the serum ferritin levels and crucial confounders of CHC patients before and after interferon-based or DAA-based anti-HCV therapy
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