Improved Serum Alpha-Fetoprotein Levels after Iron Reduction Therapy in HCV Patients

Abstract

Background and Aims. To examine the changes in serum alpha-fetoprotein (AFP) levels after iron reduction by therapeutic phlebotomy in chronic hepatitis C patients. Methods. This retrospective study included 26 chronic hepatitis C patients. The patients were developed iron depletion by repeated therapeutic phlebotomies. Results. Iron reduction therapy significantly reduced the median level of serum AFP from 13 to 7 ng/mL, ALT from 96 to 50 IU/L, gamma-glutamyl transpeptidase (GGT) from 55 to 28 IU/L, and ferritin from 191 to 10 ng/mL (P < 0.001 for each). The rate of decline in the AFP level correlated positively only with that in GGT (r = 0.695, P = 0.001), although a spurious correlation was observed between the rates of decline for AFP and ALT. The AFP level normalized (<10 ng/mL) posttreatment in eight (50%) of 16 patients who had elevated pretreatment AFP levels. Normalized post-treatment ALT and GGT levels were seen in 12% (3 of 26) and 39% (7 of 18) of the patients, respectively. Multivariate analysis identified a post-treatment GGT level of <30 IU/L as an independent factor associated with post-treatment AFP normalization (odds ratio, 21; 95% confidence interval, 1.5-293; P = 0.024). Conclusions. Iron reduction by therapeutic phlebotomy can reduce serum AFP and GGT levels in chronic hepatitis C patients.

Figure 1

Scatter diagram showing the correlation between serum GGT level, the platelet count, APRI, and serum AFP level before phlebotomy in HCV patients. (a) The serum AFP level correlated positively with the serum GGT level (r = 0.542, P = 0.004). (b) The serum AFP level correlated negatively with the platelet count (r = −0.553, P = 0.003). (c) The serum AFP level correlated positively with APRI (r = 0.531, P = 0.005).

Figure 2

Scatter diagram showing the correlation between the rates of decline in serum GGT, ferritin, and AFP levels or the total volume of blood removed and those of serum ALT levels after phlebotomy. (a) The rates of decline in ALT levels were correlated with those in GGT (r = 0.723, P < 0.001). (b) The rates of decline in ALT levels were correlated with those in ferritin (r = 0.577, P = 0.002). (c) The rates of decline in ALT levels were correlated with those in AFP levels (r = 0.511, P = 0.008). (d) The rates of decline in ALT levels were correlated with those in the total volume of blood removed (r = −0.603, P = 0.001).

Figure 3

Scatter diagram showing the correlation between the rates of decline in serum ALT or GGT levels and those of serum AFP levels after phlebotomy in HCV patients with elevated pretreatment AFP. (a) The rates of decline in AFP levels were positively correlated with those in ALT (r = 0.685, P = 0.004). (b) The rates of decline in AFP levels were positively correlated with those in GGT (r = 0.695, P = 0.003).