Clinical

Many hemophilia patients with chronic hepatitis C develop end-stage liver disease

Last Updated: 2007-05-14 10:20:07 -0400 (Reuters Health)

NEW YORK (Reuters Health) - Nearly one-fifth of hemophilia patients with chronic hepatitis C virus (HCV) infection will eventually develop end-stage liver disease (ESLD), according to a report in the May 1st issue of Blood.

Dr. Eveline P. Mauser-Bundschoten from University Medical Center Utrecht, The Netherlands, and associates explain that many patients with inherited bleeding disorders were infected with HCV before 1990 through replacement therapy with inadequate virus-inactivated clotting factor products.

The team assessed the occurrence of ESLD in 847 such patients who were infected with HCV between 1961 and 1990 and were followed until 2005.

After a median follow-up of 27 years, 19% of the patients had spontaneously cleared HCV and 81% remained chronically infected, the authors report. A quarter of the patients were coinfected with HIV.

After 35 years of infection, the cumulative incidence of ESLD was 17.1% of all patients with chronic HCV infection, the results indicate, compared with only 2.1% of patients who spontaneously cleared HCV.

The cumulative incidence of ESLD was far higher in patients coinfected with HIV (35.1%) than in HIV-negative patients (11.5%), the researchers note.

Of the 70 patients with chronic HCV infection who developed ESLD, 58 had never been treated with anti-HCV therapy and 12 were unsuccessfully treated.

During follow-up, 199 patients died, including 73 from HIV/AIDS, 55 from liver disease, and 71 from other causes.

Dr. Mauser-Bundschoten and colleagues conclude that, with longer duration of HCV infection, the risk of ESLD is emerging in patients with inherited bleeding disorders. "Future studies must be performed to study the effect of interferon-based regimens on the development of ESLD," the investigators say.

Blood 2007;109:3667-3671.