Treatment of chronic hepatitis C in haemophilia patients

Hepatitis C in haemophilia: lights and shadows

“…However, these patients are frequently resistant to IFN therapy because they are almost exclusively males, and have long-lasting infection with HCV, a high prevalence of the IFN-resistant HCV genotype 1 and high levels of viraemia, and have been exposed to multiple inoculations with HCV. Not surprisingly, therefore, monotherapy with IFN at doses of 3 MU thrice weekly for 6 months resulted in low rates (0-8%) of sustained virological response (SVR) [29], which could be marginally improved by prolonged treatments or higher cumulative treatments with IFN [30]. Conversely, combination therapy of IFN 3 MU with 1 g ribavirin for 48 weeks did increase the rates of SVR in adolescents (59%), whereas it had a negligible impact on adult haemophiliacs (15% SVR) [31].…”

The natural history of chronic hepatitis C in a cohort of HIV-negative Italian patients with hereditary bleeding disorders

“…[1][2][3][4] In fact, because the concentrates were non-virus inactivated and were prepared from a large pool of plasma, virtually all patients treated with these products were infected with HCV at the time of the first infusion. [5][6][7][8] Because the onset of the infection can be reasonably estimated (first treatment with non-virus-inactivated blood products), these patients represent a unique model for studying the natural history of HCV infection and associated complications. [9][10][11][12][13][14][15][16][17][18][19][20][21] The course of hepatitis can be accurately assessed in these patients because they are seen regularly at hemophilia centers with laboratory, clinical, and instrumental tests.…”

Interferon and ribavirin in HIV‐negative haemophiliacs with chronic hepatitis C who were nonresponders to a previous interferon treatment

“…In fact, the majority of patients with hereditary bleeding disorders who received lyophilized large donor pool factor concentrates before 1985, the year of introduction of virucidal treatment, are chronically infected by hepatitis C virus [1][2][3]. The poor responsiveness to interferon was attributed to the high prevalence of unfavourable prognostic indicators in haemophiliacs such as HCV genotype 1, HIV coinfection, the high viral load and the long duration of HCV infection [5]. The poor responsiveness to interferon was attributed to the high prevalence of unfavourable prognostic indicators in haemophiliacs such as HCV genotype 1, HIV coinfection, the high viral load and the long duration of HCV infection [5].…”

“…Hepatitis C virus (HCV)-related liver disease is now recognized as a major cause of morbidity and mortality in patients affected by hereditary bleeding disorders treated with nonvirus-inactivated clotting factor concentrates before 1985, and sometimes it is a more serious problem than the coagulopathy itself [1][2][3]. Although a large number of trials on the treatment of chronic hepatitis C has been carried out in nonhaemophilic patients [4], studies on haemophiliacs are limited and include small numbers of patients [5][6][7][8][9][10][11]. Even fewer data are available regarding the treatment of patients with hereditary bleeding disorders and chronic hepatitis C who do not respond to interferon (IFN) therapy [12].…”

“…The results of the treatment with IFN monotherapy of the haemophiliacs with HCV-related hepatitis were disappointing, with a post-treatment sustained remission rate of nearly 10% [8], which was approximately half that achieved in nonhaemophilic patients [4]. The poor responsiveness to interferon was attributed to the high prevalence of unfavourable prognostic indicators in haemophiliacs such as HCV genotype 1, HIV coinfection, the high viral load and the long duration of HCV infection [5]. Trials in nonhaemophilic untreated patients with HCV-related chronic liver disease showed that the association of ribavirin with interferon monotherapy increased the rate of sustained response up to 40% [4].…”