Treatment of hepatitis C in hemophiliacs

Abstract

Hepatitis C virus (HCV) infection is a major cause of morbidity and mortality in hemophiliacs who received nonvirucidally treated large-pool clotting factor concentrates before 1986. In fact, although many hemophiliacs infected with HCV have a slow progression of liver disease, in a minority of them hepatitis evolves toward end-stage liver disease and hepatocarcinoma. Moreover, a significant percentage of HCV-infected hemophiliacs were also coinfected with human immunodeficiency virus (HIV), which can accelerate the progression of liver disease. Thus, the aim of anti-HCV therapy is to interrupt the chronic infection in order to prevent the progression of hepatitis to cirrhosis, liver decompensation, cancer and, ultimately, death. In this review we present the literature data on anti-HCV treatment in hemophiliacs. Combination therapy with interferon (IFN) and ribavirin has improved the poor results obtained with IFN monotherapy and has become the standard treatment of chronic hepatitis C. Given the positive results obtained with pegylated interferon plus ribavirin in nonhemophiliacs, ongoing trials are evaluating this promising therapy in HCV-chronically infected hemophilic patients; preliminary results show a sustained response rate similar to that in patients without coagulopathy. Finally, based on the encouraging results in coinfected nonhemophiliacs, anti-HCV treatment should also be considered for those HIV-positive hemophiliacs in whom anti-retroviral treatment has stabilized the HIV infection. Am. J. Hematol.

Liver transplantation in the haemophilia patient

“…Morbidity and mortality associated with chronic hepatitis C have regained concern amongst haemophilia patients [15]. In most cases, liver transplantation is the only available treatment option for patients with end‐stage HCV‐related liver disease (decompensated liver cirrhosis and/or hepatocellular carcinoma) [2].…”

“…In the 1970s, the introduction of plasma factor concentrates from hundreds of donors revolutionized the care of haemophilia allowing these patients to initiate treatment at home with self‐infusions thereby controlling bleeding, leading to improved care and a longer lifespan. Unfortunately, viral inactivation processes were not in place before 1985 resulting in many haemophilia patients contracting hepatitis C [2,3].…”

Hepatitis C virus genotypes among patients with thalassemia and inherited bleeding disorders in Markazi province, Iran

“…The result also shows a lower HCV seroprevalence in patients with congenital bleeding disorders when compared with those in western countries [18][19][20][21]. In these countries, haemophilia patients were regularly treated with non-virally inactivated large pool of clotting factor for at least 10 years prior to 1985 [22,23], while Iranian haemophiliacs mostly received locally produced fresh frozen plasma and cryoprecipitate manufactured from single donor blood during this period of time. Of course, some Iranian haemophiliacs received nonvirally inactivated factor concentrates for 3 years (1994)(1995)(1996)(1997).…”

Thromboelastography Use in the Perioperative Transfusion Management of a Patient with Hemophilia A Undergoing Liver Transplantation

“…Many hemophiliacs who received clotting factors concentrates prior to the mid 1980s were infected with the hepatitis C virus and a significant group of them have progressed to cirrhosis and hepatocellular carcinoma [2]. Hemophilia is inherited as an X linked recessive trait.…”