Medical co‐morbidities of patients with haemophilia: pain, obesity and hepatitis C

Abstract

Clinical care of patients with haemophilia (PWH) has progressed rapidly over the past decade. Current therapy has allowed patients with haemophilia to live longer and many patients are now experiencing the co-morbidities of the general population. In this review article, we focus on three common diseases states that affect PWH: chronic pain, obesity and hepatitis C. Pain has been a co-morbidity for many years and PWH often have unusual needs for chronic pain relief compared to the general population. Obesity is not only increasing in the general population but also in patients with hereditary bleeding disorders. The co-morbidity of obesity not only causes increased pain progression and joint damage but also affects the dosing of factor concentrates. Finally, hepatitis C is known to have infected the majority of patients who received non-virally inactivated pooled factor concentrates in the past. New treatment regimens have been developed that allow the nearly uniform cure of chronic hepatitis C with a short course of oral medications.

Hepatitis C infection in a Greek population with inherited bleeding disorders

“…Antiviral therapy with direct-acting antivirals (DAAs) leads to sustained virological response (SVR) in more than 95% of patients with minimal adverse events and high adherence rates. 4,5 Patients with HCV with inherited bleeding disorders are a valuable cohort that enables reliable studying of slow progression of chronic HCV infection. Evidence on the risk and complications of HCV infection after long-term exposure is limited.…”

Hepatitis C in haemophilia: time for treatment for all

“…A dramatic change in the treatment of HCV is however upon us with multiple new highly effective agents such as sofosbuvir, daclatasvir, ledipasvir, simeprevir, ombitasvir, paritaprevir and dasabuvir . The current interferon‐free treatments which are often once daily oral treatments for 8–12 weeks achieve clearance in excess of 95% with virtually no side effects.…”

Hemostatic System in Chronic Viral Hepatitis

“…Recent advances in the treatment of hepatitis C should substantially decrease the risk of CLD due to HCV infection in hemophilia patients. (12) In severe forms of cirrhosis, Soria et al (13) found that fibrinogen levels tend to decrease and abnormal fibrinogen molecules can be detected. Fulminant hepatic failure caused by HEV is accompanied by disseminated intravascular coagulation.…”