Coping with the HIV epidemic 1982–2007:  25‐year outcomes of the Hershey Haemophilia Cohort

Eyster, M. Elaine

doi:10.1111/j.1365-2516.2008.01702.x

Cited by 5 publications

(8 citation statements)

References 25 publications

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“…Haemophilia patients treated with plasma‐derived CFC were exposed to HIV between 1978 and 1986. Infection rates vary from 1% in Finland to 42.1% in the USA and even 90% of patients who were intensively treated [44–46]. Before the introduction of highly active antiretroviral therapy (HAART) in 1996, many patients died.…”

Section: Hivmentioning

confidence: 99%

Co‐morbidity in the ageing haemophilia patient: the down side of increased life expectancy

2009

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Because of an increased life expectancy, (age-related) co-morbidity is becoming a common occurrence in haemophilia patients. In this review, haemophilia-related and non-haemophilia-related medical problems, treatment recommendations and psychosocial consequences in ageing haemophilia patients are discussed. Haemophilic arthropathy is an important cause of pain and disability, and a frequent indication for surgery in haemophilia patients. In addition, many adult patients are infected with hepatitis C or HIV, the consequences and treatment of which can add to physical and mental discomfort. Moreover, inhibitors against factor VIII can also develop in adulthood, especially in patients with mild haemophilia. Hypertension is reported to occur more often in haemophilia patients than in the general population. Other internal problems, like renal abnormalities, overweight, diabetes mellitus and hypercholesterolemia are discussed. Haemophilia seems to protect against cardiovascular disease, although the incidence is increasing. Recommendations are given on dealing with tooth extractions, surgical interventions and sexuality problems in patients with haemophilia. In addition to haemophilia in itself, co-morbidity has a major psychological impact, and an important effect on quality of life. It can also result in complex treatment regimens, in which coordination between health care workers is essential.

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Section: Hivmentioning

confidence: 99%

Co‐morbidity in the ageing haemophilia patient: the down side of increased life expectancy

2009

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“…At the Hemophilia Center of Central Pennsylvania, we follow a cohort of PWH who were infected with HCV more than 40 years ago . Herein, we report the long term outcomes and the response to HCV treatment in this group of individuals.…”

Section: Introductionmentioning

confidence: 99%

Long term survival in persons with hemophilia and chronic hepatitis C: 40 year outcomes of a large single center cohort

Eyster

Kong

et al. 2016

American J Hematol

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We studied the course of chronic HCV infections in a cohort of 222 persons with hemophilia (PWH) and von Willebrand disease followed at our center since 1973. Twenty two (10%) developed end stage liver disease (ESLD). Forty years after HCV infection, cumulative incidence of ESLD was 12.3% and overall survival was 45.5%. Those who were infected with HCV only (n=100) had a survival of 75.2%, while those infected with HIV (n=122) had a survival of 24% (P<.001). Survivals were significantly longer for those infected with HCV at younger age (< 15 years) compared to those infected over age 30 years (P=0.014). Cause specific deaths for ESLD and bleeding were 8.8% and 8.3% respectively. For HIV negative subjects, the annual hazard of death from ESLD and bleeding was near zero for the first 10 years, and then rose slowly over the next 20 years to 0.4/100py for ESLD and 0.2/100py for bleeding. Sixty subjects completed 79 treatment episodes. Sustained viral response rates increased from 7/21 (33%) between 1990-2001, to 17/29 (58%) between 2002-2011, and to 27/29 (93%), since 2012 with the advent of the directly acting antiviral agents. These results confirm the very slow ESLD progression rate in HIV negative PWH. However, the risk of death from both ESLD and bleeding increases steadily with longer duration of HCV infection. More aggressive surveillance to detect those with early fibrosis is needed now that curative treatment is possible in >95% of individuals.

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“…[13][14][15] Younger age at the time of HIV seroconversion has been associated with improved survival. 14,16 Most HIV-infected hemophilia patients are coinfected; among 458 HIV-positive hemophilia A and B patients in Canada, 96.5% were hepatitis C (HCV) positive.…”

Section: Viral Diseasementioning

confidence: 99%

The Aging Patient with Hemophilia: Complications, Comorbidities, and Management Issues

Philipp

2010

Hematology

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Improvements in hemophilia care and antiviral treatments have resulted in increases in median life expectancy for persons with congenital hemophilia A and B. Currently, 2% of hemophilia A and B patients surveyed in US comprehensive hemophilia treatment centers are 65 years of age or older and 15% are 45 years or older. Many of the complications of hemophilia, including intracranial hemorrhage, joint disease, and inhibitor development, increase with increasing age. Hepatocellular carcinoma and end-stage liver disease are increasing in the older hemophilia population due to infection with hepatitis C (HCV) and HCV/HIV coinfection. Older hemophilia patients also now face the same medical conditions associated with aging in the general population, including cardiovascular disease and cancer. Complex hemostatic management, sometimes in conjunction with antithrombotic management, with extensive cross-specialty clinical and laboratory coordination may be required for the care of the older hemophilia patient. Because elderly hemophilia patients currently represent a small portion of the overall hemophilia population, there is little in the way of clinical data to guide recommendations. Registry databases and cooperative group studies are needed for the development of evidence-based guidelines for the older hemophilia population, which is anticipated to expand in the future.

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Coping with the HIV epidemic 1982–2007: 25‐year outcomes of the Hershey Haemophilia Cohort

Cited by 5 publications

References 25 publications

Co‐morbidity in the ageing haemophilia patient: the down side of increased life expectancy

Co‐morbidity in the ageing haemophilia patient: the down side of increased life expectancy

Long term survival in persons with hemophilia and chronic hepatitis C: 40 year outcomes of a large single center cohort

The Aging Patient with Hemophilia: Complications, Comorbidities, and Management Issues

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