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

Abstract

Before the mid-1980s, haemophilia often was unknowingly treated with contaminated plasma products, resulting in high rates of human immunodeficiency virus (HIV-1), hepatitis C virus (HCV) and hepatitis B virus (HBV) infections. To estimate the impact of these infections, a new cohort was established. All HCV-seropositive patients, age 13-88 years, at 52 comprehensive haemophilia treatment centres were eligible. Cross-sectional data collected during April 2001 to January 2004 (median June 2002) were analysed. Plasma HIV-1 and HCV RNA were quantified by polymerase chain reaction. Highly active antiretroviral therapy (HAART) was defined as use of at least three recommended medications. Among 2069 participants, 620 (30%) had HIV-1. Of 1955 with known HBV status, 814 (42%) had resolved HBV and 90 (4.6%) were HBV carriers. Although 80% of the HIV-1-positive participants had > or = 200 CD4+ cells microL(-1), only 59% were on HAART. HIV-1 RNA was undetectable in 23% of those not taking antiretroviral medications. Most (72%) participants had received no anti-HCV therapy. HCV RNA was detected less frequently (59%) among participants treated with standard interferon plus ribavirin (P = 0.0001) and more frequently among HIV-1-positive than HIV-1-negative participants (85% vs. 70%, P < 0.0001). HIV-1-positive participants were more likely to have pancytopenia and subclinical hepatic abnormalities, as well as persistent jaundice, hepatomegaly, splenomegaly and ascites. HAART recipients did not differ from HIV-negative participants in the prevalence of ascites. The clinical abnormalities were more prevalent with older age but were not confounded by HBV status or self-reported alcohol consumption. Eleven participants presented with or previously had hepatocellular carcinoma or non-Hodgkin lymphoma. Although prospective analysis is needed, our data reveal the scale of hepatic and haematological disease that is likely to manifest in the adult haemophilic population during the coming years unless most of them are successfully treated for HIV-1, HCV or both.

Correlates of spontaneous clearance of hepatitis C virus among people with hemophilia

“…19 All patients at the collaborating comprehensive hemophilia treatment centers were invited to participate in the MHCS-II if they had reached age 13 years, had a congenital coagulation disorder (hemophilia A or B [congenital factor VIII or IX deficiency], von Willebrand disease, or other, hereafter referred to as hemophilia), and if, since January 1, 1993, they had had a positive result on a locally performed, licensed assay for HCV antibodies (anti-HCV), HIV-1 antibodies, or HIV-1 RNA. Earlier HCV and HIV-1 results were not considered to avoid false-positive results with first-generation assays.…”

“…One drink was defined as 45 mL (1.5 oz) liquor, 120 mL (4 oz) wine, or 360 mL (12 oz) beer and was estimated to contain 12 g alcohol. 19 Additional information is available at https://mhcs-ii.rti.org. Excluding those who lacked HCV RNA data sufficient to define HCV clearance (n ϭ 473, see "Definition of HCV clearance") and those with a history of interferon treatment (n ϭ 264), a final total of 712 subjects were included.…”

Circulating Serum Free Light Chains As Predictive Markers of AIDS-Related Lymphoma

“…We conducted a case-control study of NHL, nested in three cohorts of HIVpositive individuals: the Washington and New York Men's Research Study (also known as the DC Gay Men's Study, or DCG) 21 ; the Multicenter Hemophilia Cohort Study 22,23 ; and the AIDS Cancer Cohort (ACC) Study 24 (Table 1). Institutional review boards at the National Cancer Institute (NCI) and collaborating institutions approved each cohort study, and all participants gave written informed consent.…”

Impact of human immunodeficiency virus infection on the course of hepatitis C virus infection: A meta-analysis

“…Of them, 6242 were positive for HIV and 10508 were negative for HIV. Fourteen studies assessed the histological cirrhosis [9,18,19,21,[27][28][29][30][31][32]38,39,41,42] , 7 studies assessed the death [17,22,23,[34][35][36]40] , 3 studies assessed the decompensated liver disease [15,26,37] , 2 studies assessed the outcome of decompensated liver disease and death [16][17][18][19][20][21][22][23][24][25] , 1 study assessed the outcome of histological cirrhosis, hepatocellular carcinoma and death [20] , 1 study assessed the outcome of histological cirrhosis and death [24] , and 1 study assessed the outcome of hepatocellular carcinoma and death [33] , respectively. Most studies did not provide a racial distribution.…”