Association of hepatitis C virus infection with serum iron status: Analysis of data from the Third National Health and Nutrition Examination Survey

Background. There is growing evidence that mildly increased amounts of iron in the liver can increase hepatic injury, particularly if combined with other hepatotoxic factors, such as alcohol use, use of porphyrogenic drugs, or chronic viral hepatitis. In the present study, the association of hepatitis C virus ( HCV) infection with serum measurements of iron status was assessed in the US population. Methods. We analyzed data from a total of 14,462 participants in the Third National Health and Nutrition Examination Survey. We excluded subjects who were aged < 12 years, subjects for whom measurements of serum levels of iron or ferritin or the results of liver function tests were missing, and subjects who had a serum transferrin saturation of greater than or equal to50% ( to help exclude subjects with hemochromatosis). Results. Mean serum levels of ferritin and iron ( +/- standard error) were significantly higher among subjects with HCV infection ( 100 +/- 3 ng/ mL and 229 +/- 17 mug/dL, respectively) than among subjects without liver disease (83 +/- 0.3 ng/ mL and 101 +/- 2.1 mug/dL, respectively) (P < .0001). Serum levels of ferritin were directly and significantly correlated with serum levels of alanine aminotransferase, aspartate aminotransferase, and gamma-glutamyl transpeptidase (r= 0.25 r=0.24, r=0.28, respectively; P <.0001), whereas platet counts were inversely correlated with serum levels of ferritin (r = -0.12; P<.0001). Conclusion. HCV infection is significantly associated with higher serum levels of ferritin and iron in the US population.