The progression of HCV‐associated liver disease in a cohort of haemophilic patients

Abstract

We have studied morbidity and mortality related to hepatitis C virus infection in haemophilic patients treated at our centre. 11/255 HCV seropositive patients have developed hepatic decompensation. 20 years after first exposure to lyophilized clotting factor concentrate the risk of hepatic decompensation is estimated to be 10.8% (95% CI 3.8-17.8%). There is a significantly increased risk associated with HIV infection, and also with increased age. For HIV seropositive patients the rates of decline in CD4 lymphocyte count and the development of p24 antigenaemia are significant risk factors for hepatic decompensation. Cirrhosis was seen in 9/19 HIV seropositive patients at post mortem. There was an association of cirrhosis with increased age but not with CD4 count, p24 antigenaemia, or AIDS. In conclusion, HCV infection is associated with serious liver disease in haemophilic patients, but so far this has been restricted to a minority of those at risk. HIV co-infection accelerates progression to hepatic decompensation, and we speculate that this is probably due to enhanced HCV replication in the presence of immune deficiency.

The influence of human immunodeficiency virus coinfection on chronic hepatitis C in injection drug users: A long-term retrospective cohort study

“…This is also in accordance with that reported in HIV-infected hemophiliacs, in which the risk of liver failure was 11-to 21-fold increased compared with HIV-negative patients and was associated with HIV-related immunodepression. 4,5 However, when considering only necroinflammatory liver lesions, we noted that HIV infection, but not the level of immunodeficiency (as assessed by a low CD4 cell count), was associated with an increase of lesions, suggesting that HIV may per se increase HCV-related liver damage. The mechanism involved in such a phenomenon remains to be determined.…”

Sustained virological response to interferon plus ribavirin reduces liver‐related complications and mortality in patients coinfected with human immunodeficiency virus and hepatitis C virus†

“…[1][2][3][4] Despite a decline in morbidity and mortality from opportunistic infections since the introduction of highly active antiretroviral therapy (HAART), end-stage liver disease continues to be a frequent cause of hospital admission and death in populations coinfected with HIV and hepatitis C virus (HCV). 5,6 For this reason, all HIVinfected individuals with positive HCV RNA determinations should be considered as candidates for anti-HCVtreatment, providing HIV infection is wellcontrolled and there are no contraindications to therapy with interferon or ribavirin.…”

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

“…Subsequent studies indicated that progressive disease did occur [6,7] and that some patients presented with complications of cirrhosis [8]. 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].…”