Racial Differences in the Relationship Between Hepatitis C Infection and Iron Stores

Black race and increased hepatic iron stores predict poor response to interferon treatment for chronic hepatitis C virus (HCV) infection. We tested the hypothesis that these 2 observations are linked by investigating whether HCV–infected African–Americans have increased iron stores relative to uninfected persons. Using data from the third National Health and Nutrition Examination Survey (NHANES III), we determined the risk of having increased iron stores, defined as elevation of both serum ferritin and transferrin–iron saturation (TS), in HCV–RNA–positive blacks (n = 100) and nonblacks (n = 126) relative to HCV–RNA–negative blacks (n = 4,002) and nonblacks (n = 10,943). HCV–positive blacks were 5.4 times (95% CI, 1.2 to 24) more likely to have increased iron stores than HCV–positive nonblacks. The proportion of HCV–positive blacks who had increased iron stores was 16.4% among those with abnormal liver enzymes and 2.8% among those with normal liver enzymes, compared with only 0.6% among HCV–negative blacks. After adjustment for age, alcohol intake, gender, menopausal status, education, body mass index, and poverty index, HCV–positive blacks with abnormal liver enzymes had an elevated risk of having increased iron stores (odds ratio, 17.8; 95% CI, 5.1 to 63). In contrast, among persons of other races, there was a much smaller difference in the proportion of persons with increased iron stores between HCV–positive persons with (3.4%) or without (1.4%) abnormal liver enzymes and HCV–negative persons (0.9%). 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. (Hepatology 2003;37:795–801.)