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3.1.3c Interferon and Iron Reduction Therapy

A study published in the American Journal of Gastroenterology, Vol 89, No. 7, suggests that using “Iron Reduction Therapy” along with interferon can result in an effective cure rate in the area of 75-80% and that adding cytokines and antivirals such as ribavirin can improve effectiveness even further. The theory behind this is that viruses need iron to replicate, and by reducing the hepatic iron in the liver you prevent them from replicating. It should be noted that this procedure is not FDA approved. Trials have proved inconclusive.

Iron is an element required for replication of virtually all virulent microorganisms. Reducing the amount of iron helps to limit the replication of the hepatitis C virus. The role of iron influencing the natural history of viral hepatitis was reported in a study more than 15 years ago (Blumberg BS, Lustbader ED, Whitford PL. “Changes in serum iron levels due to infection with hepatitis B virus.” Proc Natl Acad Sci USA 1981;78:3222-4). In this study it was observed that patients with hepatitis B viral infection with higher serum iron or ferritin levels had greater likelihood of development of chronic infections than those with lower levels, who more often resolved their infections spontaneously.

Increases in levels of serum ferritin, iron, and transferrin saturation also have been noted with high frequencies in patients with chronic hepatitis C, and the higher levels have, in general, been associated with lesser likelihood of response to interferon therapy. Complete responders to interferon have, on average, lower hepatic iron concentrations than do non-complete responders.

In a report by Hayashi and colleagues (Am J Gastroenterol 1994;89:986-8) it was reported that iron reduction alone, by repeated venesection (bloodletting), led to significant improvement in serum alanine aminotransferase (ALT) levels in chronic hepatitis C.

Studies done since 1998, by Fong and Fontana, have shown that phlebotomy (bloodletting), combined with interferon, reduces liver inflammation, but not fibrosis. It seems to reduce the viral load, and may improve sustained response, but the results are not enough to be statistically important (Journal of Hepatology 1998; 28:369-374 and Hepatology 2000; 31:730-736). These studies were not done combining the interferon with ribavirin. To do so might be complicated, since ribavirin tends to result in anemia.

Tandon et al. (Br. J. Nutr. 1999), have shown that a special low-iron vegetarian diet was able to significantly reduce the serum iron and ferritin levels.

Bovine lactoferrin, 1.8–3.6 g/day for 8 weeks, suppressed ALT levels and viral load in 3 of 11 patients. This could be used with any combination of antiviral therapies, including IFN plus ribavirin, without side effects (Jpn. J. Cancer Res. 1999; 90: 367– 71).



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