Long-Term Follow-Up of a Portuguese Single-Centre Cohort of Persons with Haemophilia and Hepatitis C Virus Infection

Abstract

Introduction: Persons with haemophilia (PWH) used to represent a population with a high prevalence of hepatitis C virus (HCV) infection due to the use of contaminated blood products. Although the goals of antiviral therapy are the same as the general population, long real-life follow-up data regarding their outcomes are still scarce. Our aim was to report the outcomes of HCV infection and the results of antiviral therapy in PWH. Methods: A retrospective analysis was performed in a single-centre cohort of PWH with positive HCV antibody. Outcomes registered were rate of spontaneous clearance of HCV, sustained virologic response (SVR) achievement, development of end-stage liver disease, and all-cause and liver-related mortality. Results: Out of 131 PWH, 73 (55.7%) had positive HCV antibody. During a median follow-up time of 22 years, 46 patients (63.9%) developed chronic hepatitis C, of which 16 (34.8%) developed cirrhosis. Treatment was pursued in 34 PWH. Most (n = 32) were first treated with interferon (IFN)-based regimens with SVR rates of 40.6%. Direct-acting antivirals were used in 14 IFN-experienced and 2 naïve patients, with an overall SVR rate of 100%. Overall, 17 patients (23.3%) died during the follow-up, only 4 related to liver disease. Of these, none had achieved SVR. Conclusions: We describe the outcomes of a cohort of Portuguese PWH and hepatitis C exposure after two decades of follow-up, with a lower mortality than previously described. Our response rates to HCV treatment were comparable to those in the general population and stress the importance of early treatment.

Implementation of Microelimination Strategy in Eradication of Chronic Hepatitis C Infection in Patients With Hemophilia in the Northern Region of Serbia

“…A high rate of SVR was achieved in 73.6% of PwH treated with PegIFN+RBV in our cohort, in conjunction with an expected side-effects rate of 20.8%, which disproves healthcare providers' biases that PwH are difficult to treat with INF-based protocols. 4 …”

“…The severity of hemophilia was classified as mild (5–40% of normal factor level), moderate (1–5% of normal factor level), or severe (<1% of normal factor levels). 4 According to the WFH recommendations for testing PWH for blood-borne diseases, all registered patients were tested for the presence of anti-HCV antibodies. 7 …”

“… 3 Even though hemophilia has become the prime example for successful prevention in chronic illnesses using coagulation factors, the blood-borne transmission of HCV was nearly inevitable until the 1990s because of the technological processes involved in the development of blood derivatives, making this infection endemic in PwH. 4 , 5 …”

Hepatitis C Virus Infections in Patients with Hemophilia: Links, Risks and Management

“…Among them, two treatment-naïve and 14 treatment-experienced patients were treated with DAAs, with an overall SVR-12 rate of 100%. 10 An Iranian, bicentric, retrospective study reported the treatment results of 147 patients with hereditary bleeding disorders (132 of whom suffered from haemophilia) and CHC. Six (4,1%) patients were HCV/HIV co-infected and 37 (25.2%) had cirrhosis.…”