Antiviral therapy for chronic hepatitis C in patients with inherited bleeding disorders: an international, multicenter cohort study.
BACKGROUND
Hepatitis C is a major co-morbidity in patients with hemophilia. However, there is little information on the efficacy of antiviral therapy and long-term follow-up after treatment.


OBJECTIVE
To assess the effect of interferon-based (IFN-based) therapy on hepatitis C virus (HCV) eradication, to identify determinants associated with treatment response, and to assess the occurrence of end-stage liver disease (ESLD) after completing antiviral therapy.


METHODS
In a multicenter cohort study, 295 treatment-naïve hemophilia patients chronically infected with HCV were included. The effect of therapy was expressed as sustained virological response (SVR). Determinants associated with treatment response were expressed as odds ratios (ORs). Cumulative incidence of ESLD was assessed using a Kaplan-Meier survival table.


RESULTS
Among human immunodeficiency virus (HIV) negative patients (n = 235), SVR was 29% (29/101) for IFN monotherapy, 44% (32/72) for IFN with ribavirin, and 63% (39/62) for pegylated IFN (PegIFN) with ribavirin. In patients co-infected with HIV (n = 60), IFN monotherapy, IFN with ribavirin, and PegIFN with ribavirin eradicated HCV in 7/35 (20%), 1/2 (50%), and 11/23 (48%), respectively. SVR increased with genotype 2 and 3 [OR 11.0, 95% CI: 5.8-20.5], and combination therapy (IFN and ribavirin OR 3.7, 95% CI: 1.7-8.4), PegIFN and ribavirin (OR 4.2, 95% CI: 1.8-9.5). Up to 15 years after antiviral treatment, none of the patients with a SVR relapsed and none developed ESLD. In contrast, among unsuccessfully treated patients the cumulative incidence of ESLD after 15 years was 13.0%.


CONCLUSIONS
Successful antiviral therapy appears to have a durable effect and reduces the risk of ESLD considerably.
Van Creveldkliniek, University Medical Center, Utrecht, The Netherlands.
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Makris
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Fischer
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Mauser-Bunschoten
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000998:Antiviral Agents / Q000494:pharmacology / Q000627:therapeutic use*; D002648:Child; D015331:Cohort Studies; D005260:Female; D006402:Hematologic Diseases / Q000150:complications* / Q000188:drug therapy* / Q000821:virology; D019698:Hepatitis C, Chronic / Q000150:complications* / Q000188:drug therapy*; D006801:Humans; D007372:Interferons / Q000008:administration & dosage; D007391:International Cooperation; D008297:Male; D008875:Middle Aged; D012254:Ribavirin / Q000008:administration & dosage; D016896:Treatment Outcome
D000998:Antiviral Agents; D012254:Ribavirin; D007372:Interferons