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Medline ® Abstract for Reference 60

of 'Clinical manifestations and natural history of chronic hepatitis C virus infection'

60
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Long-term follow-up of hepatitis C infection in a large cohort of patients with inherited bleeding disorders.
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Fransen van de Putte DE, Makris M, Fischer K, Yee TT, Kirk L, van Erpecum KJ, Patch D, Posthouwer D, Mauser-Bunschoten EP
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J Hepatol. 2014 Jan;60(1):39-45. Epub 2013 Aug 23.
 
BACKGROUND&AIMS: Patients with inherited bleeding disorders are an interesting group to study the long-term course of chronic hepatitis C virus (HCV) infection, because of their uniform mode of infection and reliable follow-up. Our aim was to assess the long-term occurrence of adverse liver-related events in these patients.
METHODS: The occurrence and determinants of end-stage liver disease (ESLD) were assessed using retrospective data of 863 HCV infected patients with inherited bleeding disorders from the Netherlands and the UK.
RESULTS: Median follow-up since HCV infection was 31 years, while 30% of patients had>35 follow-up years. Nineteen percent of patients spontaneously cleared the virus and 81% developed chronic HCV infection. Of the 700 patients with chronic HCV, 90 (13%) developed ESLD. Hepatocellular carcinoma (HCC) was diagnosed in 3% of patients with chronic HCV, 41% of which occurred in the last six years. Determinants of ESLD development were age at infection (hazard ratio (HR) 1.09 per year increase), HIV co-infection (HR 10.85), history of alcohol abuse (HR 4.34) and successful antiviral treatment (HR 0.14). Of the 487 patients who were still alive at the end of follow-up, 49% did not undergo optimal conventional antiviral treatment.
CONCLUSIONS: After over 30 years of HCV infection, ESLD occurred in a significant proportion of patients with inherited bleeding disorders. HCC appears to be an increasing problem. There is a significant potential for both conventional and new antiviral treatment regimens to try and limit ESLD occurrence in the future.
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Van Creveldkliniek, Department of Hematology, University Medical Center Utrecht, Utrecht, The Netherlands. Electronic address: D.E.FransenvandePutte@umcutrecht.nl.
PMID