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.

Cost‐effectiveness analysis of alternative factor VIII products in treatment of haemophilia A

“…Because of treatment with older and less safe FVIII products, many haemophilic patients are already infected with HIV and/or hepatitis viruses [14,15]. Rather than conducting the analysis for every combination of these problems, we addressed it to three basic health conditions.…”

Percutaneous liver biopsy in adult haemophiliacs with hepatitis C virus: safety of outpatient procedure and impact of human immunodeficiency virus coinfection on the spectrum of liver disease

“…However, prior to 1992, patients who received transfusions of blood or blood products were also a risk for acquiring HCV. This was particularly true in those with haemophilia as patients who were treated with non-viral-inactivated clotting factors have a prevalence of HCV of 90% [3][4][5]. Because of the similar mode of transmission, human immunodeficiency virus (HIV) is also common in those with haemophilia [6,7] and coinfection with HIV/HCV is now a cause of significant morbidity and mortality in this population [8][9][10].…”

Prevalence of conditions associated with human immunodeficiency and hepatitis virus infections among persons with haemophilia, 2001–2003

“…Between 1978 and 1986, human immunodeficiency virus (HIV-1) also was transmitted through contaminated clotting factor concentrates. As a consequence, two-thirds of the HCV-infected haemophilia patients in the USA and many other countries were co-infected with HIV-1 [1][2][3]. Prevalence rates of these viruses have fallen in more recent years because of births subsequent to screening and viral inactivation of plasma products and because of mortality, particularly from HIV-1.…”

“…During the HAART era of the past 8 years, survival with HIV-1 improved greatly. However, concern about the complications of HCV increased [9,10], as only about 5% of HIV-1 co-infected patients spontaneously clear HCV viraemia [1][2][3][4]6]. In addition, the risk of decompensated ESLD is eightfold higher with HIV-1 co-infection, developing in 14% of co-infected persons with haemophilia during 16 years of follow-up [6].…”