Author: John C. Martin
Author Date: 4/14/2003

Black race and high iron levels in the liver may be connected in
explaining poor responses to hepatitis C treatment, according to a
new study.

Hepatitis C is the most common viral infection in the U.S.
Approximately 2 percent of the U.S. population, which translates to
about 4 million people, are infected. Of those, 50-85 percent
progress from the acute form of the virus, to the more insidious
chronic form. Chronic HCV is the main cause of liver transplantation
in this country.(1)

The treatment options for hepatitis C have improved over the years,
including the development of longer-lasting pegylated interferons,
combined with the antiviral drug, ribavirin. This is the treatment
of choice with documented response rates of up to 50 percent in
patients with the most common "genotype 1" strain of the virus, and
up to an 80 percent response rate in people with genotypes 2 and 3.
(2)

How successful treatment may or may not be, however, depends on
several factors, including the HCV genotype(3), viral load(4),
increased levels of iron in the liver(5), and a patients race(6).
People with higher iron levels tend not to respond as effectively to
treatment compared to those with lower levels, scientists maintain.

Iron Levels and Treatment Outcome
Based on the factors that studies found can negatively affect
treatment outcome, scientists at the University of Washington, and
the Northwest Hepatitis C Resource Center in Seattle, set out to
determine if two of those factors were linked to poor interferon
response rates.(7)

"Black race and increased hepatic [liver] iron stores predict poor
response to interferon treatment for chronic hepatitis C virus
infection," the investigators wrote. "We tested the hypothesis that
these two observations are linked by investigating whether HCV-
infected African-Americans have increased iron stores relative to
uninfected persons."

Taking data from the third National Health and Nutrition Examination
Survey, conducted between 1988 and 1994, the investigators
determined the risk of having increased liver iron levels in 100
African-Americans who had tested positive for hepatitis C and a
group of 126 HCV-positive non-blacks, and compared those individuals
to a group of 4002 African-Americans without HCV as well as a group
of 10,493 non-blacks who tested negative for the virus.

The National Health and Nutrition Examination Survey is a series of
comprehensive studies headed by the Centers for Disease Control and
Prevention (CDC) to assess Americans dietary intake and its
relationship with disease. The survey originated in 1960.(8)

Hepatitis and High Iron Levels
The scientists discovered that African-Americans with the virus were
nearly 5.5 times at greater risk of having increased levels of iron
than HCV-positive individuals of other races. "The proportion of HCV-
positive blacks who had increased iron stores was 16.4 percent among
those with abnormal liver enzymes, and 2.8 percent among those with
normal liver enzymes, compared with only 0.6 percent among HCV-
negative blacks," they wrote.

After ruling out other possible factors that might affect iron
levels, the investigators concluded that African-Americans with
hepatitis C faced nearly 18 times the risk of having higher iron
levels. Among other races, the scientists found a much smaller
difference in the proportion of people with increased iron levels
between HCV-positive individuals with or without abnormal liver
enzymes, and those who are HCV-negative.

They wrote: "In conclusion, a greater proportion of blacks than
persons of other races respond to HCV infection with an increase in
iron stores. This finding may partly explain the reduced response of
HCV-positive African-Americans to antiviral treatment."