Clinical

Hepatitis C seems milder in patients with hemophilia

Last Updated: 2007-08-23 15:05:34 -0400 (Reuters Health)

By David Douglas

NEW YORK (Reuters Health) - Chronic infection with hepatitis C virus (HCV) does not appear to be as severe in hemophiliacs as it is in comparable patients without hemophilia, researchers report in the August issue of the American Journal of Gastroenterology.

As lead investigator Dr. Nimer Assy told Reuters Health, "HCV in hemophiliacs has a more benign course than non-hemophiliacs." This appears to be due to the "importance of thrombosis and vascular factors in the pathogenesis of cirrhosis."

In fact, Dr. Assy of Sieff Hospital, Upper Galilee, Israel and colleagues point out that because cirrhosis is associated with thromboses of the intrahepatic vasculature, HCV infections in hemophiliacs may show different characteristics from those in other patients.

To investigate, the researchers studied liver biopsies from 12 hemophiliacs and 20 matched non-hemophiliac controls.

Serum aspartate aminotransferase levels were significantly lower in the hemophiliacs and partial thromboplastin time was significantly longer than in controls.

Histological activity and fibrosis scores were significantly lower in the hemophiliacs. Moreover, none of the hemophiliacs had evidence of advanced diseases with bridging fibrosis or cirrhosis compared to 7 (30%) of the controls.

Overall, 6 of the hemophiliacs (86%) were infected with genotype 1a or 1b HCV compared to 8 (46%) of the controls. The remaining subjects had genotype 2b, 3a or 3b disease.

Thus, despite the greater prevalence of the more virulent 1a and 1b genotypes in the hemophiliacs, concluded Dr. Assy there was "no worse histology."

If these findings are confirmed, say the researchers, "long-term treatment of chronic HCV infection may include the use of anticoagulants or antiplatelet agents."

Am J Gastroenterol 2007;102:1672-1676.