The Effect of HCV Treatment With DAA on Iron Overload and Ferritin Levels: A Case Series

Abstract

Introduction: Patients with chronic hepatitis C (CHC) are at increased risk for iron overload. Studies showed that chronic HCV patients treated with Pegylated Interferon (PEG-IFN) and who achieved sustained virologic response recovered from impaired hepcidin secretion leading to iron overload. Other studies showed that Hepatitis C virus-induced oxidative stress suppresses hepcidin expression [2,3]. HCV treatment has been transformed with the availability of direct acting anti-virals (DAAs), and SVR rates now exceed 90%. In this series, we report all patients in our practice with CHC who had an elevated serum ferritin or iron prior to treatment with DAAs and compare with levels after treatment with DAAs. To our knowledge, this is the first case series reporting outcomes in patients with high baseline iron and/or ferritin in the DAA era.2859_A Figure 1. No Caption available.Methods: We included all patients who were referred to our hepatology clinic for HCV treatment and evaluation. Data from patients who had ferritin level > 400 at the initial evaluation were collected. Results: There were 12 patients with high ferritin and/or iron/iron sat levels who met the criteria. Average age was 59 ±8 years. There were 9 (75%) males. A decrease in the levels of iron was noticed in 11/12 individuals. The average decrease in iron after treatment was 69.27 (range of 8 -149). The average decrease in ferritin was 648.25 (figure 1, table 1). 7 patients (58.3%) were alcohol users and 6 of them had quit drinking. 10 (83.33%) achieved SVR. 1 patient had compound C282Y-H63D heterozygote mutation and 2 patients had H63D homozygous mutation. Conclusion: Patients with CHC with elevated baseline iron level and/or ferritin level treated with DAAs saw a significant decrease in their iron, iron saturation and ferritin levels within a short period even in patients with hemochromatosis mutations. Whether this decrease was because of clinical factors, viral factors, genetic factors or an interplay between all three needs to be further investigated. Long term studies are needed to determine the clinical impact of decreasing iron/ferritin levels in these patients.