Marked iron overload related to ribavirin and iron sulfate treatment in a patient with active viral C cirrhosis.

Increased ferritin levels are common in the course of chronic hepatitis C, regardless of antiviral therapy. Usually, this increase in ferritin levels has minimal clinical and biological impact, and drops after therapy discontinuation. We report here on a dramatic increase in ferritin levels in a cirrhotic patient with hepatitis C treated by ribavirin monotherapy and oral iron sulphate, and discuss the possible mechanisms of this deleterious effect.

Prevalence of hepatitis C infection and risk factors in hospitalized diabetic patients: results of a cross-sectional study.

OBJECTIVES: Although there may exist a nosocomial risk of hepatitis C virus (HCV) infection in patients with type 1 or type 2 diabetes, this risk has not been fully investigated thus far and its magnitude is unknown. The aim of this multicenter cross-sectional study was to evaluate the prevalence of, and risk factors for, hepatitis C infection in consecutive hospitalized patients with diabetes and to assess the nosocomial risk and magnitude of HCV infection in these patients. PATIENTS AND METHODS: Consecutive hospitalized patients with diabetes seen in 11 French hepatogastroenterology and diabetology departments were studied. The prevalence of anti-HCV antibodies was compared with that observed in healthy blood donors and individuals seen during routine medical checkup. Diabetic patients with anti-HCV antibodies were compared with patients without anti-HCV antibodies for assessment of risk factors. RESULTS: In total 1561 patients were studied. Independent risk factors for HCV infection were assessed through multivariate analysis. Thirty-three patients (2.11%) had anti-HCV antibodies and 21 (63.70%) had HCV identified risk factors. The prevalence of HCV infection was higher in patients with diabetes than in blood donors (0.08%) or healthy controls (0.20%) (P<0.001). Multivariate analysis identified four independent risk factors for HCV infection: blood transfusion before 1991 [odds ratio (OR)=2.88, P=0.033], intravenous drug use (OR=21.37, P=0.012), treatment in a hepatogastroenterology center (OR=4.17, P=0.002) and a high number (>2) of previous admissions since the onset of diabetes (OR=2.52, P=0.039). CONCLUSION: A nosocomial source of HCV infection in hospitalized diabetic patients is suggested by the increased risk of HCV infection associated with the number of hospitalizations. This may account for at least 36% of cases of HCV infection.

Occurrence of porphyria cutanea tarda during peginterferon/ribavirin therapy for chronic viral hepatitis C.

Porphyria cutanea tarda (PCT) is a metabolic disorder characterized by a reduced hepatic activity of uroporphynogen decarboxylase (URO-D), an enzyme of the heme synthesis. The clinical features of PCT may be brought into light by hepatic injury induced by hepatitis C virus (HCV). A significant association between HCV and PCT is well recognized, although the role of HCV in the appearance of PCT is still debated because confounding factors often coexist, such as alcohol, other viruses, drugs or iron overload (). HCV therapy may improve PCT although PCT was rarely reported as a de novo occurrence during an interferon/ribavirin therapy (Jessner et al. Hepatology 2002;36:1301-1302); here, we describe two such other cases.

[Seroprevalence of hepatitis A and cost evaluation of different vaccination strategies against hepatitis A virus in patients with chronic hepatitis C in France]. / Séroprévalence de l'infection par le virus de l'hépatite A et évaluation du coût direct de différentes stratégies vaccinales contre le virus de l'hépatite A chez les malades atteints d'hépatite chronique C en France.

OBJECTIVES: To prospectively determine the prevalence of total hepatitis virus A antibodies in patients with chronic hepatitis C and to evaluate the direct costs of several vaccination strategies against hepatitis A virus in these patients. METHODS: From April 1 to July the 31 1998, 219 patients with hepatitis C virus antibodies underwent a systematic testing for total hepatitis virus A antibodies (MEIA-AXSYM, Abbott laboratories). The prevalence of hepatitis A virus antibodies was evaluated according to age and suspected way of hepatitis C contamination. This prevalence has been compared to that in individuals undergoing a check-up provided by the national health insurance system stratified by age. Direct costs of 2 vaccination strategies "A" and "B" were evaluated according to age (<40 vs > 40 years) and number of vaccine doses (1 or 2). "A" strategy included the systematic vaccination of all patients without determining the presence of total hepatitis A antibodies. "B" strategy included testing for total hepatitis A antibodies and vaccination of seronegative patients. The costs of these two strategies (A and B) were calculated with one and two vaccine doses. RESULTS: The prevalence of total hepatitis A antibodies was 76% in the entire population. It increased after the age of 35 and was statistically higher in patients who were older than 40 than in patients younger than 40. This prevalence was not significantly different from that in individuals who underwent a check-up provided by the national health insurance system stratified according to age. "B" strategy with 2 vaccine doses was less expensive that A strategy in the whole population and in patients younger than 40. This strategy was less expensive with 1 vaccine dose except in patients who had recently screened positive for hepatitis C antibodies younger than 40 when it induced an increased in direct cost due to the low prevalence of total hepatitis A antibodies in these patients. CONCLUSIONS: In patients with hepatitis C antibodies with a high prevalence of total hepatitis A antibodies, testing for the prevalence of these antibodies before vaccination decreases the direct cost of this vaccination.