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Hepatitis C Less Severe with Hemophilia

October 15, 2007

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The lack of clotting factor in hemophiliacs' blood reduces their ability to form clots in the liver, therefore reducing their liver's ability to scar. Israeli researchers propose this to be the reason that Hepatitis C infection is less severe in hemophiliacs.

Is Chronic Hepatitis C Virus Infection More Benign in Patients With Hemophilia?

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Hemophiliacs, who have a bleeding disorder that requires the administration of donated clotting factor, have a high rate of infection with blood-borne viruses including HCV, HBV, and HIV. Such infections were much more common before routine implementation of infection-control measures including donor screening and treatment of blood products.

Liver cirrhosis is associated with the development of thromboses (blood clots) of the intrahepatic vasculature. Because hemophiliacs lack clotting factor, this raises the possibility that HCV-related liver disease progression in hemophiliacs may differ from that of non-hemophiliac patients with hepatitis C.

As reported in the August 2007 American Journal of Gastroenterology, Israeli researchers analyzed liver biopsies from 12 hemophiliacs and 20 non-hemophiliac control subjects with chronic hepatitis C matched for age and sex. The mean ages of the hemophiliacs and the controls were 35 and 40 years, respectively. Biopsy samples were compared for inflammatory activity and fibrosis.

Results

• 6 of the 7 hemophiliac patients (86%) but only 8 of 17 control subjects (46%) were infected with HCV genotypes 1a or 1b, with the remainder having 2b, 3a, or 3b.

• Serum aspartate aminotransferase (AST) levels were lower (44 +/- 13 vs 70 +/- 43 U/L) and partial thromboplastin times (PTT) were longer (49.2 +/- 16.9 vs 31.2 +/- 1.2 s.) in the hemophiliac patients compared with the control subjects.

• Biopsy results showed that histological activity scores (1.9 +/- 0.6 vs 3.6 +/- 2.7) and fibrosis scores (0.3 +/- 0.2 vs 1.5 +/- 1.5) were significantly lower in the hemophiliacs compared with the control subjects.

• None of the hemophiliacs had histological evidence of advanced liver disease (bridging fibrosis or cirrhosis), compared with 30% of the control subjects.

Conclusion

Based on these results, the authors concluded, "HCV infections in hemophiliacs may be less severe than in HCV infected patients without hemophilia."

09/25/07

Reference
N Assy, N Pettigrew, SS Lee, and others. Are Chronic Hepatitis C Viral Infections More Benign in Patients With Hemophilia? Am J Gastroenterol 102(8): 1672-1676. August 2007

Posted by Editors at October 15, 2007 9:30 AM