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

Abstract

Both HCV and HIV are common in haemophiliacs previously treated with non-viral-inactivated clotting factor concentrates. Because of increased bleeding risks, little data are available on the safety of percutaneous outpatient liver biopsy (LBx) and impact of HIV coinfection in this population. This study aims at reporting our experience with percutaneous LBx in a cohort of haemophiliacs infected with HCV and describe the spectrum of disease and impact of HIV coinfection. A retrospective review of consecutive patients with haemophilia and HCV who underwent percutaneous LBx was performed. All patients were positive for HCV RNA by commercial assay and received factor concentrate prior to biopsy. A total of 29 male patients (mean age 36, 24 haemophilia A, five haemophilia B, and 44% coinfected with HIV) underwent successful outpatient percutaneous LBx without bleeding complication. Histologic activity index was 6.44 with advanced fibrosis (bridging fibrosis/cirrhosis) in 31%. When patients were stratified by HIV positive (n = 13) vs. HIV negative (n = 16), coinfected patients had higher fibrosis scores and higher proportion advanced fibrosis (54% vs. 12%; P = 0.0167) with no differences in age, demographic or other laboratory parameters. Multivariate logistic regression found that HIV positivity was independently associated with advanced fibrosis (OR = 3.7; 95% CI: 1.17-11.8; P = 0.026). Outpatient percutaneous LBx can be safely performed in patients with haemophilia. Despite similar age, HIV coinfection was an independent predictor of advanced fibrosis. These data support the hypothesis that HIV accelerates fibrosis progression in those coinfected with HCV and highlights the importance of liver histology in this population.

Relationship between various hepatic function scores and the formation of esophageal varices in patients with HIV/hepatitis C virus co‐infection due to contaminated blood products for hemophilia

“…Especially in hemophilia patients, measurement of prothrombin time or INR is not often carried out because of the apparent abnormal value expected. Therefore, the ALICE score or the APRI and FIB‐4, which was also reported by our group previously, could be useful markers for non‐invasive monitoring tools, as both are correlated with the severity of liver fibrosis and/or cirrhosis as a surrogate indicator for detecting esophageal varices …”

Replacement therapy for invasive procedures in patients with haemophilia: literature review, European survey and recommendations

“…Literature review. A total of 26 papers published between 1977 and 2007 were reviewed [49–74] (Table 3). These studies included 778 procedures performed in 713 patients (Haemophilia A: 526; Haemophilia B: 68; unspecified: 119).…”

Sustained Long-Term Antiviral Maintenance Therapy in HCV/HIV-Coinfected Patients (SLAM-C)

“…HCV/HIV coinfection is associated with increased rates of fibrotic progression, higher rates of cirrhosis in cross-sectional analyses and more rapid progression to end-stage liver disease compared to those with either HCV or HIV monoinfection 2–7. An analysis comparing HCV monoinfected and coinfected hemophilics showed that coinfection was associated with higher fibrosis scores and a higher proportion of advanced fibrosis/cirrhosis after controlling for age, demographic features or other laboratory parameters 8. Treatment of HCV in the setting of HCV/HIV coinfection yields suboptimal results with a significant decrement in sustained viral response compared to those with HCV monoinfection who undergo interferon-based therapies 9…”