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Amato VS, Maia de Souza R, Moyses Franco LA, Ruedas Martins RC, Maia da Silva CA, Emori CT, Celeste BJ, Castanheira GV, Tuon FF. Case Report: Cutaneous Leishmaniasis in a Rheumatoid Arthritis Patient Receiving Methotrexate. Am J Trop Med Hyg 2022; 107:785-788. [PMID: 36067991 PMCID: PMC9651513 DOI: 10.4269/ajtmh.22-0180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 06/27/2022] [Indexed: 11/07/2022] Open
Abstract
The immunosuppressive effect of methotrexate has rarely been associated with reactivation of cutaneous leishmaniasis. Here we present a case of a cutaneous leishmaniasis patient with atypical clinical symptoms without splenomegaly but with cutaneous manifestations after treatment of rheumatoid arthritis with methotrexate and blood recovery of the parasite. Next-generation sequencing was used to identify Leishmania infantum chagasi in the patient's blood sample.
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Affiliation(s)
- Valdir Sabbaga Amato
- Universidade de São Paulo, Instituto de Medicina Tropical de São Paulo, Laboratório de Parasitologia, São Paulo, São Paulo, Brazil
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Moléstias Infecciosas e Parasitárias, São Paulo, São Paulo, Brazil
| | - Regina Maia de Souza
- Universidade de São Paulo, Instituto de Medicina Tropical de São Paulo, Laboratório de Parasitologia, São Paulo, São Paulo, Brazil
| | - Lucas Augusto Moyses Franco
- Universidade de São Paulo, Instituto de Medicina Tropical de São Paulo, Laboratório de Parasitologia, São Paulo, São Paulo, Brazil
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Moléstias Infecciosas e Parasitárias, São Paulo, São Paulo, Brazil
| | - Roberta Cristina Ruedas Martins
- Universidade de São Paulo, Instituto de Medicina Tropical de São Paulo, Laboratório de Parasitologia, São Paulo, São Paulo, Brazil
| | - Camila Alves Maia da Silva
- Universidade de São Paulo, Instituto de Medicina Tropical de São Paulo, Laboratório de Parasitologia, São Paulo, São Paulo, Brazil
| | - Christini Takemi Emori
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Moléstias Infecciosas e Parasitárias, São Paulo, São Paulo, Brazil
| | - Beatriz Julieta Celeste
- Universidade de São Paulo, Instituto de Medicina Tropical de São Paulo, Laboratório de Soroepidemiologia, São Paulo, São Paulo, Brazil
| | - Gabriel Victor Castanheira
- Universidade de São Paulo, Instituto de Medicina Tropical de São Paulo, Laboratório de Parasitologia, São Paulo, São Paulo, Brazil
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Moléstias Infecciosas e Parasitárias, São Paulo, São Paulo, Brazil
| | - Felipe Francisco Tuon
- Laboratory of Emerging Infectious Diseases, Pontificia Universidade Católica do Paraná, Curitiba, Paraná, Brazil
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Emori CT, Uehara SNO, Amaral AC, Carvalho-Filho RJ, Moreira SR, Sandra de Souza E Silva I, Lanzoni VP, Silva-Souza AL, Gama RA, Soares Nunes EJ, Serra Leopércio AP, Appel F, Regina de Almeida Carvalho S, Benedito Silva AE, Medina-Pestana JO, Gomes Ferraz ML. Observational Study Evaluating the Outcome of Cirrhotic Hepatitis C Patients Submitted to Renal Transplantation. Transplant Proc 2020; 52:89-96. [PMID: 32000943 DOI: 10.1016/j.transproceed.2019.10.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 10/06/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND After renal transplantation (RTx) hepatitis C virus (HCV) is associated with higher morbidity and mortality resulting in lower patient and graft survival. Few studies have investigated the evolution of renal transplant patients with cirrhosis owing to HCV. The objectives were to evaluate the post-transplant evolution of cirrhotic patients and to compare them with noncirrhotic patients considering the outcomes, including hepatic decompensation, graft loss, and death. METHODS The retrospective-cohort study analyzed the data of patients undergoing RTx between 1993 and 2014, positive anti-HCV, HCV-RNA before RTx, and availability of data for assessment of cirrhosis. Demographic, clinical, and laboratory variables were compared between the groups according to the outcomes. The same were made between cirrhotic patients with and without portal hypertension (PH). Survival curves were constructed by the Kaplan-Meier test and compared by the log-rank test. Variables associated with the outcomes were analyzed using Cox regression. RESULTS This study included noncirrhotic (n = 201) and cirrhotic patients (n = 23). In cirrhotic patients, they were significantly older (49 vs 41.6 years) and mostly male (87% vs 65%), with a greater number of previous RTx (48% vs 18%), less frequent use of azathioprine (26% vs 54%), cyclosporine (13% vs 46.5%), more frequent use of tacrolimus (87% vs 55%), lower count of platelets × 1000 cells/mm3(110 vs 187), and higher pre-RTx international normalized ratio (1.20 vs 1.1).The Kaplan-Meier survival differed in cirrhotic vs noncirrhotic patients only in hepatic decompensation. Cox regression analysis identified pretransplant cirrhosis (hazard ratio 6.64, 95% confidence interval, 2.59-17.06) and tacrolimus (hazard ratio 3.17,95% confidence interval, 1.05-9.58) as variables independently associated with decompensation. CONCLUSIONS Patients with HCV and cirrhosis exhibit higher morbidity when submitted to RTx than noncirrhotic patients, with a higher risk of hepatic decompensation. However, no difference was observed in liver-related mortality, suggesting that RTx is a feasible option in cirrhotic patients without decompensation, even if they have PH.
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Affiliation(s)
| | | | - Ana Cristina Amaral
- Department of Gastroenterology, Federal University of São Paulo, São Paulo, Brazil
| | | | | | | | | | | | - Raimundo Araújo Gama
- Department of Gastroenterology, Federal University of São Paulo, São Paulo, Brazil
| | | | | | - Flávia Appel
- Department of Gastroenterology, Federal University of São Paulo, São Paulo, Brazil
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Pierre AMMA, Feldner ACDCA, Carvalho Filho RJD, Lopes EPDA, Gouvea MSG, Pinho JRR, Carvente CT, Emori CT, Silva GAD, Ferraz MLCG. Prevalence of hepatitis delta virus among hemodialysis and renal transplant patients. Int J Artif Organs 2018; 41:171-174. [PMID: 29546807 DOI: 10.1177/0391398817752989] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Hepatitis B virus infection is an important cause of liver disease in hemodialysis patients and renal transplant recipients. Hepatitis Delta virus is a defective virus transmitted by the same route of hepatitis B virus, which requires the helper function of hepatitis B virus. Data about hepatitis B virus/hepatitis delta virus coinfection are scarce and there are no studies regarding the coinfection among hemodialysis patients and renal transplant in our country. OBJECTIVE This study aimed to investigate the prevalence of hepatitis delta virus infection among hemodialysis patients and renal transplant recipients. METHODS Cross-sectional study analyzing virological markers of hepatitis B virus and hepatitis delta virus infection and biochemical and clinical features of liver disease of patients infected with hepatitis B virus in hemodialysis and renal transplant. RESULTS A total of 117 HBsAg-positive patients (46 hemodialysis and 71 renal transplant) were included. The mean age was 48.5 ± 11.8 years and 67% were males. Antiviral therapy was given to 74% of patients. Liver function tests were within the normal range. HBeAg-positive was found in 35% of patients and median hepatitis B virus DNA was 2.98 log (IU/mL). Cirrhosis was detected in 26.5% of patients. The prevalence of anti-hepatitis delta virus total antibody (+) was 1.7% (2/117). None of the 2 patients had active hepatitis delta virus infection, since all samples tested negative for hepatitis delta virus-RNA. CONCLUSION The results suggest a low prevalence rate of coinfection B and D in hemodialysis and renal transplant recipients in this population.
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de Oliveira Uehara SN, Emori CT, Perez RM, Mendes-Correa MCJ, de Souza Paiva Ferreira A, de Castro Amaral Feldner AC, Silva AEB, Filho RJC, de Souza E Silva IS, Ferraz MLCG. High incidence of tuberculosis in patients treated for hepatitis C chronic infection. Braz J Infect Dis 2016; 20:205-9. [PMID: 26867472 PMCID: PMC9427596 DOI: 10.1016/j.bjid.2015.12.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Revised: 12/01/2015] [Accepted: 12/06/2015] [Indexed: 12/19/2022] Open
Abstract
Brazil is one of the 22 countries that concentrates 80% of global tuberculosis cases concomitantly to a large number of hepatitis C carriers and some epidemiological risk scenarios are coincident for both diseases. We analyzed tuberculosis cases that occurred during α-interferon-based therapy for hepatitis C in reference centers in Brazil between 2001 and 2012 and reviewed their medical records. Eighteen tuberculosis cases were observed in patients submitted to hepatitis C α-interferon-based therapy. All patients were human immunodeficiency virus-negative. Nine patients (50%) had extra-pulmonary tuberculosis; 15 (83%) showed significant liver fibrosis. Hepatitis C treatment was discontinued in 12 patients (67%) due to tuberculosis reactivation and six (33%) had sustained virological response. The majority of patients had a favorable outcome but one died. Considering the evidences of α-IFN interference over the containment of Mycobacterium tuberculosis, the immune impairment of cirrhotic patients, the increase of tuberculosis case reports during hepatitis C treatment with atypical and severe presentations and the negative impact on sustained virological response, we think these are strong arguments for latent tuberculosis infection screening before starting α-interferon-based therapy for any indication and even to consider IFN-free regimens against hepatitis C when a patient tests positive for latent tuberculosis infection.
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Affiliation(s)
| | - Christini Takemi Emori
- Gastroenterology Division, Universidade Federal de São Paulo (UNIFESP), Sao Paulo, SP, Brazil
| | - Renata Mello Perez
- Internal Medicine Department, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
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Wahle RC, de Mello Perez R, Takemi Emori C, de Oliveira Uehara SN, da Silva Fucuta P, Melo Rocha C, de Castro Amaral Feldner AC, de Souza E Silva IS, Carvalho-Filho RJ, Silva AEB, Gomes Ferraz ML. Does hepatitis B virus coinfection have any impact on treatment outcome in hepatitis C patients on hemodialysis? Ann Hepatol 2016; 14:317-24. [PMID: 25864211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND HBV/HCV coinfection is a common finding among hemodialysis patients. However, there is scarce information concerning the impact of HBV coinfection on the response to treatment of HCV-infected patients on hemodialysis. AIM We aimed to compare the rate of sustained virologic response (SVR) to treatment with interferon-alfa (IFN) between hemodialysis patients with HBV/HCV coinfection and those with HCV-monoinfection. MATERIAL AND METHODS HCV-infected patients on hemodialysis treated with IFN were included. Patients coinfected by HBV/HCV were compared to HCV-monoinfected patients, regarding clinical and biochemical features and rates of SVR. RESULTS One hundred and eleven patients were treated. HBV/HCV coinfection was observed in 18/111 patients (16%). Coinfected patients were younger (p = 002), had more time on dialysis (p = 0.05) and showed a tendency to present a higher prevalence of septal fibrosis (p = 0.06). The analysis by intention to treat showed SVR of 56% among coinfected patients and 18% in HCV-monoinfected patients (p = 0.004). CONCLUSION In conclusion, end-stage renal disease patients with HBV/HCV coinfection exhibit higher rate of SVR to HCV treatment than HCV-monoinfected patients. It is possible that factors related to the host immune response and viral interaction could explain the better response observed among coinfected patients.
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Affiliation(s)
- Raul Carlos Wahle
- Discipline of Gastroenterology, Department of Medicine, Federal University of São Paulo (UNIFESP), Brazil
| | - Renata de Mello Perez
- Department of Internal Medicine, Federal University of Rio de Janeiro and D'Or Institute for Research and Education, Rio de Janeiro, Brazil
| | - Christini Takemi Emori
- Discipline of Gastroenterology, Department of Medicine, Federal University of São Paulo (UNIFESP), Brazil
| | | | - Patrícia da Silva Fucuta
- Discipline of Gastroenterology, Department of Medicine, Federal University of São Paulo (UNIFESP), Brazil
| | - Cristina Melo Rocha
- Discipline of Gastroenterology, Department of Medicine, Federal University of São Paulo (UNIFESP), Brazil
| | | | | | | | - Antônio E Benedito Silva
- Discipline of Gastroenterology, Department of Medicine, Federal University of São Paulo (UNIFESP), Brazil
| | - Maria Lucia Gomes Ferraz
- Discipline of Gastroenterology, Department of Medicine, Federal University of São Paulo (UNIFESP), Brazil
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Emori CT, De Oliveira Uehara SN, De Carvalho-Filho RJ, De Souza e Silva IS, Amaral Feldner AC, Lanzoni VP, Benedito Silva AE, Gomes Ferraz ML. REATIVAÇÃO DE LEISHMANIOSE DURANTE TRATAMENTO DE HEPATITE B CRÔNICA COM ALFAINTERFERONA 2B. Rev Patol Trop 2015. [DOI: 10.5216/rpt.v44i3.38021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Wahle RC, Perez RM, Pereira PF, Oliveira EMG, Emori CT, Uehara SNDO, Silva ISDS, Silva AEB, Ferraz MLG. Hepatitis B virus reactivation after treatment for hepatitis C in hemodialysis patients with HBV/HCV coinfection. Braz J Infect Dis 2015; 19:533-7. [PMID: 25997784 PMCID: PMC9427496 DOI: 10.1016/j.bjid.2015.04.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Revised: 12/30/2014] [Accepted: 04/17/2015] [Indexed: 12/30/2022] Open
Abstract
In coinfected HBV/HCV patients, HBV replication is usually suppressed by HCV over the time. No study to date has evaluated the HBV viremia in long-term follow-up after HCV treatment in hemodialysis patients with HBV/HCV coinfection. This study aimed to assess the evolution of HBV viremia after HCV treatment in this special population. Ten hemodialysis patients with HBV/HCV coinfection with dominant HCV infection (HBV lower than 2000 IU/mL) and significant fibrosis were treated with interferon-alpha 3 MU 3×/week for 12 months and could be followed for at least 36 months after HCV treatment. Six cases of HBV reactivation (60%) during follow-up were observed and 5/6 had been successfully treated for HCV. Patients with HBV reactivation received anti-HBV therapy. Our preliminary findings indicate that treatment of hepatitis C in HBV/HCV coinfected hemodialysis patients may favor HBV reactivation. Thus, continued monitoring of HBV viremia must be recommended and prompt anti-HBV therapy should be implemented.
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Affiliation(s)
- Raul Carlos Wahle
- Discipline of Gastroenterology, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil.
| | - Renata Mello Perez
- Department of Internal Medicine, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | - Patrícia Fucuta Pereira
- Discipline of Gastroenterology, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | | | - Christini Takemi Emori
- Discipline of Gastroenterology, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | | | | | | | - Maria Lucia Gomes Ferraz
- Discipline of Gastroenterology, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
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de Oliveira Uehara SN, Emori CT, da Silva Fucuta Pereira P, Perez RM, Pestana JOM, Lanzoni VP, e Silva ISS, Silva AEB, Ferraz MLCG. Histological evolution of hepatitis C virus infection after renal transplantation. Clin Transplant 2012; 26:842-8. [PMID: 22594774 DOI: 10.1111/j.1399-0012.2012.01635.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2012] [Indexed: 02/06/2023]
Abstract
BACKGROUND information regarding histological progression of hepatitis C after renal transplant (RTx) is scarce. AIMS To analyze clinical and laboratory evolution and histological progression of hepatitis C in patients evaluated before and after RTx. METHODS Twenty-two HCV-infected patients submitted to liver biopsy pre- and post-RTx were included. A semiquantitative analysis of necroinflammatory activity and fibrosis staging was performed and the two biopsies were compared. RESULTS Patients were mostly men (73%) with mean age of 36±9 yr. Time post-transplant was 4±2 yr and time between biopsies was 5±2 yr. An elevation of alanine aminotransferase (p=0.041) and aspartate aminotransferase (p=0.004) levels was observed in the post-transplant period. Fibrosis progression after renal transplantation was observed in 11 (50%) of the patients, and necroinflammatory activity worsening was observed in 7 (32%) of the patients. The histological progression occurred even among those without significant histological lesions in pre-transplant biopsy. CONCLUSION The findings of this study suggest that the practice of indicating treatment in the pre-transplant phase based mainly on histological disease should be revised, because a high proportion of patients present disease progression. Because interferon cannot be used safely after RTx, treatment should be indicated for all ESRD patients with hepatitis C.
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Narciso-Schiavon JL, Schiavon LDL, Carvalho-Filho RJD, Hayashida DY, Wang JHJ, Souza TS, Emori CT, Ferraz MLG, Silva AEB. Clinical characteristics associated with hepatic steatosis on ultrasonography in patients with elevated alanine aminotransferase. SAO PAULO MED J 2010; 128:342-7. [PMID: 21308157 PMCID: PMC10948078 DOI: 10.1590/s1516-31802010000600006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2010] [Revised: 09/16/2010] [Accepted: 09/24/2010] [Indexed: 01/21/2023] Open
Abstract
CONTEXT AND OBJECTIVE The main causes of hepatic steatosis (HS) are alcoholic liver disease and nonalcoholic fatty liver disease (NAFLD). Although liver biopsy is the gold standard for NAFLD diagnosis, the finding of abnormal aminotransferases in abstinent individuals, without known liver disease, suggests the diagnosis of NAFLD in 80-90% of the cases. Identification of clinical factors associated with HS on abdominal ultrasound may enable diagnoses of fatty liver non-invasively and cost-effectively. The aim here was to identify clinical variables associated with HS in individuals with elevated alanine aminotransferase (ALT) levels. DESIGN AND SETTING Cross-sectional study in a single tertiary care center. METHODS Individuals with elevated ALT, serologically negative for hepatitis B and C, were evaluated by reviewing medical files. Patients who did not undergo abdominal ultrasonography were excluded. RESULTS Among 94 individuals included, 40% presented HS on ultrasonography. Compared with individuals without HS, those with fatty liver were older (P = 0.043), with higher body mass index (BMI) (P = 0.003), diabetes prevalence (P = 0.024), fasting glucose levels (P = 0.001) and triglycerides (P = 0.003). Multivariate analysis showed that BMI (odds ratio, OR = 1.186; 95% confidence interval, CI: 1.049-1.341; P = 0.006) and diabetes mellitus (OR = 12.721; 95% CI: 1.380-117.247; P = 0.025) were independently associated with HS. CONCLUSIONS Simple clinical findings such as history of diabetes and high BMI may predict the presence of HS on ultrasonography in individuals with elevated ALT and negative serological tests for hepatitis.
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Pereira PDSF, Silva ISDSE, Uehara SNDO, Emori CT, Lanzoni VP, Silva AEB, Ferraz MLG. Chronic hepatitis C: hepatic iron content does not correlate with response to antiviral therapy. Rev Inst Med Trop Sao Paulo 2010; 51:331-6. [PMID: 20209268 DOI: 10.1590/s0036-46652009000600004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2009] [Accepted: 10/28/2009] [Indexed: 12/16/2022] Open
Abstract
The complex interaction between hepatitis C virus infection, iron homeostasis and the response to antiviral treatment remains controversial. The aim of this study was to evaluate the influence of hepatic iron concentration (HIC) on the sustained virological response (SVR) to antiviral therapy in patients with chronic hepatitis C. A total of 50 patients who underwent pretreatment liver biopsy with assessment of HIC by graphite furnace atomic absorption spectroscopy and were subsequently submitted to antiviral treatment with interferon/peginterferon and ribavirin were included in the study. Patients with alcoholism, history of multiple blood transfusion, chronic kidney disease, hemolytic anemia and parenteral iron therapy were excluded. The iron related markers and HIC were compared between those who achieved an SVR and non-responders (NR) patients. The mean age was 45.7 years and the proportion of patients' gender was not different between SVR and NR patients. The median serum iron was 138 and 134 microg/dL (p = 0.9), the median serum ferritin was 152.5 and 179.5 ng/mL (p = 0.87) and the median HIC was 9.9 and 8.2 micromol/g dry tissue (p = 0.51), for SVR and NR patients, respectively. Thus, hepatic iron concentration, determined by a reliable quantitative method, was not a negative predictive factor of SVR in patients with chronic hepatitis C presenting mild to moderate hepatic iron accumulation.
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