A multicenter study of viral hepatitis in a United States hemophilic population

Abstract

Hemophilia A and B patients seen at nine US regional treatment centers were tested for serologic markers of hepatitis B virus (HBV), hepatitis C virus (HCV), and hepatitis delta virus (HDV) during 1987 and 1988. Because human immunodeficiency virus (HIV) infection, a potentially confounding variable, was present in 53% of the group, the population was divided by HIV status for analysis purposes. In the HIV-positive group (N = 382), less than 1% had not been infected with HBV, HCV, or HDV, whereas 75% had evidence of infection with HBV and 98% with HCV. HBsAg, a marker of active HBV infection, was present in 12% of subjects; 96% of these were HCV positive. Anti-HDV was detected in 35 subjects (9.1%); all were anti-HBc positive. Ten of the 35 (29%) also were positive for IgM anti-HDV, indicating current infection. All 10 were HBsAg positive and 7 of the 9 tested were HDV RNA positive. Severe/moderate hemophilia B patients were more likely to have experienced an HBV infection and to be anti-HDV positive than were similar hemophilia A patients (22% v 8%, P < .05). In the HIV-negative group (N = 345), the subjects were younger and had less severe hemophilia than the HIV-positive patients. No evidence of HBV, HCV, or HDV infection was found in 18%, whereas 33% had experienced HBV infection and 79% were anti-HCV positive. Within this group, 4% were HBsAg positive. All 13 subjects with anti-HDV (4% of the HIV-negative group) also possessed anti-HBc. One (7.7%) was IgM anti-HDV positive and the serum from another contained HDV RNA. Both of these individuals were HBsAg positive. As in the HIV-positive group, severe/moderate hemophilia B patients were more likely to be HBV and HDV positive than were hemophilia A patients (9% v 3%, P < .05). A prevalence study of viral hepatitis in a large US hemophilic population showed that active infection with HCV is common, occurring in 89% of all study patients regardless of HIV status. Evidence of active HBV infection was found in 8%; 19% of these were actively infected with HDV. HDV was more common in hemophilia B patients after controlling for disease severity.

Risk factors for infection with HBV and HCV in a largecohort of hemophiliac males

“…In addition, this cohort would have been the first to benefit from the screening of blood donors using the surrogate markers ALT (begun in late 1986) and anti‐HBc (begun in early 1987), testing that was associated with a markedly decreased risk of HCV infection from blood transfusions 33 . The higher prevalence of HCV that we observed among patients exposed to factor IX preparations than among those exposed to FVIII products in the late 1980s is consistent with other reports 24,33 and may be due to the slower development of effective virus‐inactivation processes for factor IX products.…”

“…The risk factors that were associated with markers of HBV or HCV infection among tested individuals in our cohort, including disease severity, HIV infection, and amount of clotting factor used, have been identified previously 7,22–25 . We found that the prevalence of markers of HBV infection and of HIV and HCV infection declined gradually and at a roughly similar rate among birth cohorts from 1973 to 1985.…”

“…However, this bias affects only the generalizability of our overall prevalence estimate and is present in all studies of hepatitis prevalence in PWHs. For example, HCV prevalence estimates vary from 64 percent to more than 90 percent, depending upon the source of the patient population in the study 12,23,24,35–37 …”

Treatment of chronic hepatitis C in haemophilia patients

“…Early studies using first‐generation assays have underestimated the prevalence of the infection in this group [912–13]. Later studies, that used second‐generation enzyme‐linked immunosorbent assay and various confirmatory tests, demonstrated 89% (649 of 727) anti‐HCV positivity in a heterogeneous group of patients from the United States and 98% (176 of 179) in Dutch haemophiliacs who had been exposed to large pool non‐virally inactivated coagulation factor concentrates [14,15]. Some patients seemed anti‐HCV positive in first‐generation tests, but were negative in subsequent more sensitive and specific tests [16].…”

Quality of life in adult patients with haemophilia – a single centre experience from Sweden

“…Due to plasma contamination many patients have been infected until the early 1990s with blood‐borne viruses such as HIV [11] and Hepatitis C [12]. However, at the Malmoe centre the last infection with HCV is dated to 1986.…”