The natural history of HCV in a cohort of haemophilic patients infected between 1961 and 1985
- aHaemophilia Centre and Haemostasis Unit, Royal Free Hospital, London, UK, bDepartment of Population Sciences and Primary Care, Royal Free and University College Medical School, University College, London, UK, cDepartment of Medicine, Royal Free and University College Medical School, University College, London, UK
- Professor Christine Lee, Haemophilia Centre and Haemostasis Unit, Royal Free Hospital, Pond Street, London NW3 2QG, UK.
- Accepted 22 June 2000
AIM This study describes the long term follow up of haemophilic patients infected with hepatitis C virus (HCV) between 1961 and 1985.
METHODS Clinical and treatment records from 310 patients with inherited coagulation disorders treated with blood product before 1985 were reviewed. Standard survival analysis methods were used to model progression to liver failure and death.
RESULTS A total of 298/305 (98%) patients tested were anti-HCV positive. Twenty seven (9%) individuals consistently HCV polymerise chain reaction negative were considered to have cleared the virus. By 1 September 1999, 223/310 (72%) were alive, 26 (8%) had died a liver related death, and 61 (20%) had died from other, predominantly human immunodeficiency virus (HIV) related, causes. Kaplan-Meier progression rates to death from any cause and liver related deaths 25 years after exposure to HCV were 47% (95% confidence intervals (CI) 34–60) and 19% (95% CI 10–27), respectively. After 13.3 years from 1985, by which time all patients had seroconverted to HIV, progression rates to death from any cause and liver related deaths were, respectively, 8% (95% CI 4–13) and 3% (95% CI 0.4–6) for those HIV negative, and 57% (95% CI 48–66) and 21% (95% CI 13–31) for those HIV positive (p=0.0001). Using Cox proportional hazard models, the adjusted relative hazard of death for individuals coinfected with HIV compared with those infected with HCV alone was 19.47 (95% CI 9.22–41.10), 0.99 (95% CI 0.39–2.53), 3.47 (95% CI 1.40–8.63), and 9.74 (95% CI 3.91–24.26) for the age groups at infection 10–19 years, 20–29 years, and >30 years, respectively, compared with the age group <10 years. The adjusted relative hazard for genotype 1 compared with other genotypes was 2.7 (95% CI 1.36–5.15) .
CONCLUSIONS While 25 year follow up of 310 haemophilic patients has shown the potentially lethal combination of HIV and HCV coinfection, HCV singly infected individuals show slow progression of liver disease.
8th United European Gastroenterology Week The UEGW abstract book (Gut 2000;47(suppl III)) has again been produced as a CD-ROM and can be found attached to the inside back cover of this issue.
- Abbreviations used in this paper:
- hepatitis C virus
- human immunodeficiency virus
- polymerase chain reaction
- hepatitis B surface antigen
- hepatocellular carcinoma