Prevalence of hepatitis C virus infection in porphyria cutanea tarda: systematic review and meta-analysis
Introduction
Hepatitis C virus (HCV) infection is a major public health problem worldwide, with a global prevalence of 170 million people affected [1]. The enormous burden of chronic HCV infection over the next two decades has been estimated mainly concerning the consequences of liver disease [2], but no definite information exists regarding the incidence and outcome of related extrahepatic conditions. HCV has been associated with several extrahepatic manifestations, including essential mixed cryoglobulinemia, membranoproliferative glomerulonephritis, non-Hodgkin's lymphoma, and some dermatological conditions such as lichen planus, vitiligo and porphyria cutanea tarda (PCT) [3], [4].
PCT, the most common form of porphyria, is caused by reduced activity of uroporphyrinogen decarboxilase [5], [6]. In the sporadic form of the disease, the enzyme activity is decreased to 50% in the hepatocytes only, whereas in the less common familial form, the enzymatic defect is also present in other cells types, such as erithrocytes [7]. However, this enzymatic defect itself is not sufficient to produce a PCT phenotype because most persons with this degree of decrease have no symptoms or signs of PCT [5], [6]. The extrinsic factors that modulated this expression include alcohol consumption, estrogens, and iron overload [5], [6]. The onset of PCT is characterized by the development of cutaneous lesions, increased skin fragility, bruising, and the appearance of vesicles and bullae that may become hemorrhagic. Liver disease is seen in almost all cases of PCT, the cause of which is incompletely known [5], [6]. Extensive epidemiological evidence favors the pathogenic implications of HCV. Thus, the prevalence of HCV infection has been reported to be increased in patients with PCT, although considerable geographical variation is observed [3], [8]. The aim of our study was to conduct a systematic review on the prevalence of HCV infection in PCT, and to perform a meta-analysis of studies comparing the prevalence of HCV infection in patients with PCT and in respective controls.
Section snippets
Types of studies and participants
Studies evaluating the prevalence of HCV infection in patients with PCT were considered. Only case-control studies comparing the prevalence of HCV infection in patients with PCT and in respective controls were eligible for inclusion in the meta-analysis.
Types of outcome measures
The outcome considered in this review was ‘prevalence of HCV infection’.
Search strategy for identification of studies
Bibliographical searches were performed in MEDLINE (January 1966 to January 2003), EMBASE (January 1988 to January 2003) and CINAHL (January 1982 to January 2003) electronic
Results
Three studies identified with the search strategy were excluded from the calculations of this systematic review because all of the included patients were HIV-positive [11], [12], [13]. Thus, the 50 studies identified assessing the prevalence of HCV infection in patients PCT and fulfilling the inclusion criteria are summarized in Table 1 [14], [15], [16], [17], [18], [19], [20], [21], [22], [23], [24], [25], [26], [27], [28], [29], [30], [31], [32], [33], [34], [35], [36], [37], [38], [39], [40]
Discussion
Epidemiological data suggest a strong association between HCV and PCT, as mean prevalence of HCV infection calculated from 2167 patients in the 50 studies included in our systematic review was 47% (Table 1). Furthermore, the high prevalence of HCV in PCT was confirmed in the case-control studies included in our meta-analysis (Table 3). Thus, when comparing HCV prevalence in PCT patients and in healthy controls, the OR for this association was as high as 275. In addition, both biochemical [19],
Acknowledgements
We are indebted to Brenda Ashley for assistance with the English. Supported in part by a Grant from the Instituto de Salud Carlos III (C03/02).
References (79)
- et al.
Extrahepatic manifestations of hepatitis C among United States male veterans
Hepatology
(2002) - et al.
a review and update
J Am Acad Dermatol
(2001) - et al.
Detection of hepatitis C virus by polymerase chain reaction and recombinant immunoblot assay 3.0 in porphyria cutanea tarda
Hepatology
(1995) - et al.
Hemochromatosis genes and other factors contributing to the pathogenesis of porphyria cutanea tarda
Blood
(2000) - et al.
Porphyria cutanea tarda and hepatitis C virus: a case-control study and meta-analysis of the literature
J Am Acad Dermatol
(1999) - et al.
Hepatitis C virus infection detected by viral RNA analysis in porphyria cutanea tarda
J Infect
(1997) - et al.
Liver cancer risk is increased in patients with porphyria cutanea tarda in comparison to matched control patients with chronic liver disease
J Hepatol
(2001) - et al.
Is hepatitis C virus infection a trigger of porphyria cutanea tarda?
Lancet
(1993) - et al.
Hepatitis C in patients with porphyria cutanea tarda
J Am Acad Dermatol
(1994) - et al.
High prevalence of hepatitis C virus infection in Japanese patients with porphyria cutanea tarda
Hepatology
(1997)
Porphyria cutanea tarda in Brazilian patients: association with hemochromatosis C282Y mutation and hepatitis C virus infection
Am J Gastroenterol
HCV infection in porphyria cutanea tarda
Lancet
Porphyria cutanea tarda and hepatitis C and B viruses infection: a retrospective study
Hepatology
Ascorbic acid deficiency in porphyria cutanea tarda
J Lab Clin Med
The C282Y mutation in the haemochromatosis gene (HFE) and hepatitis C virus infection are independent cofactors for porphyria cutanea tarda in Australian patients
J Hepatol
Low prevalence of hepatitis C virus infection in porphyria cutanea tarda in Germany
Hepatology
Normalization of urinary porphyrin level and disappearance of skin lesions after successful interferon therapy in a case of chronic hepatitis C complicated with porphyria cutanea tarda
J Hepatol
The prevalence of hepatitis C virus infection in the United States, 1988 through 1994
N Engl J Med
Estimating future hepatitis C morbidity, mortality, and costs in the United States
Am J Public Health
Hepatitis C: a multifaceted disease. Review of extrahepatic manifestations
Ann Intern Med
Porphyria cutanea tarda
Semin Liver Dis
The Porphyrias
Curr Treat Options Gastroenterol
Familial and sporadic porphyria cutanea: two different diseases
Hum Genet
Porphyria cutanea tarda in human immunodeficiency virus-seropositive men: case report and literature review
J Acquir Immune Defic Syndr
Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis of Observational Studies in Epidemiology (MOOSE) group
J Am Med Assoc
Porphyria cutanea tarda in association with human immunodeficiency virus infection: it is related to hepatitis C virus infection?
Arch Dermatol
Porphyrin abnormalities in acquired immunodeficiency syndrome
Arch Dermatol
Porphyria cutanea tarda associated with human immunodeficiency virus infection
Eur J Dermatol
virus infection: a possible promoting agent in porphyria cutanea tarda
Ital J Gastroenterol
Porphyria cutanea tarda, hepatitis C, and HFE gene mutations in North America
Hepatology
Porphyria cutanea tarda and hepatitis C viral infection. A clinical and virologic study
Arch Dermatol
[Porphyria cutanea tarda and hepatitis C virus infection. Clinical and virological study]
Ann Dermatol Venereol
High prevalence of hepatitis C virus infection in patients with porphyria cutanea tarda in Poland
Clin Exp Dermatol
Influence of hepatitis C virus (HCV) infection on porphyrin and iron metabolism in porphyria cutanea tarda (PCT) patients
Med Sci Monit
HFE mutations and transferrin receptor polymorphism analysis in porphyria cutanea tarda: a prospective study of 36 cases from southern France
Br J Dermatol
Porphyria cutanea tarda: multiplicity of risk factors including HFE mutations, hepatitis C, and inherited uroporphyrinogen decarboxylase deficiency
Dig Dis Sci
Hepatitis C virus and porphyria cutanea tarda: evidence of a strong association
Hepatology
Lack of association between porphyria cutanea tarda and alpha 1-antitrypsin deficiency
Eur J Gastroenterol Hepatol
Serum lipoproteins in patients with porphyria cutanea tarda
Med Clin (Barc)
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