Chronic hepatitis C treated with phlebotomy alone: biochemical and histological outcome

Background. In patients with chronic hepatitis C, the histological outcome of long term phlebotomy is unknown. Aim. To investigate biochemical and histological findings before and after phlebotomy in chronic hepatitis C. Patients. Twenty-four non-haemochromatotic patients with chronic hepatitis C were treated with long-term phlebotomy alone. Results. Hepatic iron concentration had decreased in all patients who underwent a second liver biopsy, two years after iron depletion was attained and maintained. Histological grading score decreased in four patients, was unchanged in two, and increased in five. Histological staging score decreased in two patients, was unchanged in five, and increased in four. Pretreatment high serum selenium level predicted the reduction of the inflammatory grading score in univariate analysis [p=0.008], while low serum aspartate aminotransferase [p=0.02] and low propeptide of procollagen III [p=0.08] levels predicted the lack of progression of liver fibrosis. Furthermore, when iron depletion was reached, significant reductions of serum levels of aminotransferase, gamma glutamyl transferase [-47%], propeptide of procollagen III, alpha foetoprotein, selenium were observed in 24 patients. No changes in serum hepatitis C virus-RNA levels were found. Conclusions. Phlebotomy alone seems to be efficacious in suppressing progression of chronic hepatitis C in some patients. Phlebotomy not only induces iron depletion, but it even modifies serum levels of other trace elements involved in the balance between oxidant and antioxidant processes.