We welcome the comments of Gomi and colleagues regarding our report1 of porphyrin abnormalities in patients with the acquired immunodeficiency syndrome. The absence of a porphyria cutanea tarda (PCT)—like pattern in the patients with hepatitis C studied by Gomi et al is in agreement with findings from a similar study. O'Reilly et al2 studied patients negative for the human immunodeficiency virus (HIV) and positive for the hepatitis C virus (HCV). Only 1 of 34 women who contracted HCV from immunization with RH0(D) immune globulin had mildly abnormal porphyrin profiles some 20 years after infection. In the same study, HCV-positive, HIV-negative intravenous drug abusers had no significant abnormalities in porphyrin metabolism. The authors concluded that HCV infection alone is insufficient to cause porphyrin metabolism derangement.
There is now good evidence to support an adverse effect of HIV on the course of HCV. Among individuals with
O'Connor WJ, Murphy G, Darby C, Mulcahy F, O'Moore R, Barnes L. Type of Impaired Porphyrin Metabolism Caused by Hepatitis C Virus Is Not Porphyria Cutanea Tarda but Chronic Hepatic Porphyria-Reply. Arch Dermatol. 1997;133(9):1171. doi:10.1001/archderm.1997.03890450122021