Changing causes of death in Pennsylvania's hemophiliacs 1976 to 1991: impact of liver disease and acquired immunodeficiency syndrome [letter]

Me, Eyster; Jh, Schaefer; Ragni, MV; Gorenc, TJ; Shapiro, Sandor S.; Cutter, Susan; Mk, Kajani; Abrams, Jennifer; Barron, LE; Odenwelder, A

doi:10.1182/blood.v79.9.2494.bloodjournal7992494

Cited by 11 publications

(10 citation statements)

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“…Chronic HCV and HIV remain major health concerns in those with haemophilia, especially in patients who received factor transfusions prior to available screening tests for HCV and HIV and widespread use of viral inactivated clotting factors [8][9][10]. Because of the increased bleeding risk associated with liver biopsy, despite a high prevalence of HCV, there are little data on the spectrum of liver histology of HCV and the impact of HIV coinfection in this population.…”

Section: Discussionmentioning

confidence: 99%

“…This was particularly true in those with haemophilia as patients who were treated with non-viral-inactivated clotting factors have a prevalence of HCV of 90% [3][4][5]. Because of the similar mode of transmission, human immunodeficiency virus (HIV) is also common in those with haemophilia [6,7] and coinfection with HIV/HCV is now a cause of significant morbidity and mortality in this population [8][9][10]. With improvements in anti-HCV therapy, for both those with [11][12][13] and without HIV [14][15][16], accurate assessment of liver disease has become increasingly important.…”

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confidence: 99%

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Percutaneous liver biopsy in adult haemophiliacs with hepatitis C virus: safety of outpatient procedure and impact of human immunodeficiency virus coinfection on the spectrum of liver disease

Sterling¹,

Lyons²,

Stravitz³

et al. 2007

Haemophilia

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Both HCV and HIV are common in haemophiliacs previously treated with non-viral-inactivated clotting factor concentrates. Because of increased bleeding risks, little data are available on the safety of percutaneous outpatient liver biopsy (LBx) and impact of HIV coinfection in this population. This study aims at reporting our experience with percutaneous LBx in a cohort of haemophiliacs infected with HCV and describe the spectrum of disease and impact of HIV coinfection. A retrospective review of consecutive patients with haemophilia and HCV who underwent percutaneous LBx was performed. All patients were positive for HCV RNA by commercial assay and received factor concentrate prior to biopsy. A total of 29 male patients (mean age 36, 24 haemophilia A, five haemophilia B, and 44% coinfected with HIV) underwent successful outpatient percutaneous LBx without bleeding complication. Histologic activity index was 6.44 with advanced fibrosis (bridging fibrosis/cirrhosis) in 31%. When patients were stratified by HIV positive (n = 13) vs. HIV negative (n = 16), coinfected patients had higher fibrosis scores and higher proportion advanced fibrosis (54% vs. 12%; P = 0.0167) with no differences in age, demographic or other laboratory parameters. Multivariate logistic regression found that HIV positivity was independently associated with advanced fibrosis (OR = 3.7; 95% CI: 1.17-11.8; P = 0.026). Outpatient percutaneous LBx can be safely performed in patients with haemophilia. Despite similar age, HIV coinfection was an independent predictor of advanced fibrosis. These data support the hypothesis that HIV accelerates fibrosis progression in those coinfected with HCV and highlights the importance of liver histology in this population.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Percutaneous liver biopsy in adult haemophiliacs with hepatitis C virus: safety of outpatient procedure and impact of human immunodeficiency virus coinfection on the spectrum of liver disease

Sterling¹,

Lyons²,

Stravitz³

et al. 2007

Haemophilia

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“…Moreover, it is unclear whether HCV infection by itself shortens the normal individual's life [29]. Even [30]. We therefore estimated that 0%±5% of the HCV+ users of IP/ VHP products experience liver failure, with a midrange ®gure of 2.5%.…”

Section: Health Risk Model 2: Patient Hiv± But Hcv+mentioning

confidence: 99%

Cost‐effectiveness analysis of alternative factor VIII products in treatment of haemophilia A

1999

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Manufactured factor VIII (FVIII) concentrates of varying purity are available for managing patients with haemophilia A. This study is a cost-effectiveness analysis of ultra-high purity and recombinant (UHP/R) FVIII products relative to intermediate and very-high purity (IP/VHP) preparations. Because the societal (including research and development) costs of FVIII products are unknown and product prices vary with market conditions, we conducted the analysis with treatment cost as a variable quantity. We estimated the largest price premium that could be paid for a UHP/R concentrate relative to an IP/VHP concentrate such that the UHP/R product is the more cost-effective preparation. In the analysis haemophilic patients were assumed to be seropositive for human immunodeficiency virus, seropositive for hepatitis C (HCV), or at risk for seroconversion of hepatitis A (HAV) or hepatitis B (HBV). The results showed that the maximum cost-effective UHP/R price premium is essentially zero if the patient is only at risk of HAV or HBV infection, positive but small for the base-case HCV+ patient, and positive and large for the base-case HIV+ patient having a short life expectancy. Thus UHP/R preparations are not uniformly more cost-effective than IP/VHP products across the spectrum of haemophilic patients' health problems, and the relative cost-effectiveness of the two classes of prepared FVIII products is sensitive to product prices. The methodology employed here can be used in other circumstances where multiple treatments exist for illnesses for which there are significant multiple comorbidities or health risks.

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“…These discrepancies may be explained by differences in the duration of infection. Cirrhosis was the primary or an associated cause of death in 8-11% of deaths in hemophilic patients [9,10]. Human immunodeficiency (HIV) co-infection is also an important contributor to the development of cirrhosis and liver failure [8,11].…”

Section: Introductionmentioning

confidence: 99%

A Canadian multicenter retrospective study evaluating transjugular liver biopsy in patients with congenital bleeding disorders and hepatitis C: Is it safe and useful?

et al. 2005

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Prior to the introduction of virally inactivated clotting factor concentrates, the majority of individuals with congenital bleeding disorders became infected with the hepatitis C virus. Although liver biopsy is valuable in prognosis and guiding antiviral therapy, there is a reluctance to perform biopsies in this population because of the risk of hemorrhage. The purpose of this study was to evaluate the safety of transjugular liver biopsy, and the usefulness of evaluating liver histology in this patient population. Liver histopathology was assessed by the METAVIR index and compared with corrected sinusoidal pressures, platelet counts, and abdominal ultrasonography. Liver biopsy was performed at seven Canadian centers in 65 patients with hemophilia or von Willebrand's disease. Biopsies were done on an outpatient basis, followed by a 4‐hr observation period in hospital. Normal hemostasis was maintained during the peribiopsy period, with follow‐up doses of factor concentrate self administered by the patient at home. One patient (1.4%) had significant bleeding leading to readmission and red cell transfusion. Liver histology showed 14 patients (22%) had cirrhosis. Ten patients had elevated corrected sinusoidal pressures; 7 of these (70%) had cirrhosis on biopsy, and the other 3 (30%) likely had cirrhosis although histology showed stage 3 fibrosis. This series represents the largest reported experience of transjugular biopsy in individuals with congenital bleeding disorders. We conclude that this procedure can be safely performed on an outpatient basis. The diagnosis of cirrhosis and/or portal hypertension was made in a substantial proportion of individuals (26%), all of whom had asymptomatic liver disease. Am. J. Hematol. 78:85–93, 2005. © 2005 Wiley‐Liss, Inc.

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Changing causes of death in Pennsylvania's hemophiliacs 1976 to 1991: impact of liver disease and acquired immunodeficiency syndrome [letter]

Cited by 11 publications

References 0 publications

Percutaneous liver biopsy in adult haemophiliacs with hepatitis C virus: safety of outpatient procedure and impact of human immunodeficiency virus coinfection on the spectrum of liver disease

Percutaneous liver biopsy in adult haemophiliacs with hepatitis C virus: safety of outpatient procedure and impact of human immunodeficiency virus coinfection on the spectrum of liver disease

Cost‐effectiveness analysis of alternative factor VIII products in treatment of haemophilia A

A Canadian multicenter retrospective study evaluating transjugular liver biopsy in patients with congenital bleeding disorders and hepatitis C: Is it safe and useful?

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