title: Survival of hepatitis C-infected haemophilia patients is predicted by presence of cirrhosis but not by anti-viral treatment.
abstract: OBJECTIVE
  Hepatitis C (HCV) is a major cause of morbidity and mortality in haemophilia patients who received clotting factor concentrates before the availability of virus-inactivated factors in the mid-1980s. Recently, it has been suggested that anti-HCV treated patients, particularly those achieving a sustained virological response (SVR) have an improved outcome. We sought to examine the survival of treated and untreated HCV-infected haemophilia patients.
  
  
  METHODS
  We studied overall and liver-related survival of patients with haemophilia and other congenital bleeding disorders between 2000 and 2010. The outcome was compared in 3 sub-groups: HCV mono-infected (N = 127), HCV/HIV co-infected (N = 28), and patients with either HCV-antibodies negative or persistent HCV RNA-negative (referred to as non-infected) (N = 45). Sixty-two (40%) (HCV and HCV/HIV) patients underwent anti-HCV treatment with an SVR rate of 40.3%.
  
  
  RESULTS
  Overall and liver-related 10-year survival were: 82.1 and 89.3%, 95.3 and 99.2 and 100% for HCV/HIV co-infected, HCV mono-infected and non-infected haemophilia patients, respectively (p = 0.015 and 0.023 for comparisons of HCV/HIV vs. HCV; p = 0.003 for comparison of HCV/HIV and non-infected). One HCV mono-infected and 3 co-infected patients died of end-stage liver disease (2 underwent liver transplantation). There was no survival benefit from anti-HCV treatment or from attaining of an SVR. Only clinically suspected cirrhosis remained as an independent predictor of survival.
  
  
  CONCLUSIONS
  The prognosis of haemophilia patients who acquired HCV/HIV co-infection is worse than that of HCV mono-infected or non-infected or haemophiliacs. This is mainly due to liver-related mortality. Anti-HCV treatment or SVR had no observable impact on survival rate.
authors.affiliation: Department of Gastroenteroloy and Hepatology.
authors.forename: Yaakov
authors.initials: Y
authors.lastname: Maor
authors.affiliation: The Israeli National Hemophilia Center (INHC), Sheba Medical Center, Tel-Hashomer, Israel.
authors.forename: Jonathan M
authors.initials: JM
authors.lastname: Schapiro
authors.affiliation: The Israeli National Hemophilia Center (INHC), Sheba Medical Center, Tel-Hashomer, Israel.
authors.forename: Dalia
authors.initials: D
authors.lastname: Bashari
authors.affiliation: The Israeli National Hemophilia Center (INHC), Sheba Medical Center, Tel-Hashomer, Israel.
authors.forename: Uri
authors.initials: U
authors.lastname: Martinowitz
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000998:Antiviral Agents / Q000627:therapeutic use*; D025861:Blood Coagulation Disorders, Inherited / Q000150:complications; D015331:Cohort Studies; D060085:Coinfection; D018450:Disease Progression; D005260:Female; D015658:HIV Infections / Q000150:complications; D006467:Hemophilia A / Q000150:complications*; D016174:Hepacivirus / Q000235:genetics; D019698:Hepatitis C, Chronic / Q000150:complications / Q000188:drug therapy / Q000401:mortality*; D006801:Humans; D007372:Interferons / Q000627:therapeutic use; D008103:Liver Cirrhosis / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D011092:Polyethylene Glycols; D011379:Prognosis; D012367:RNA, Viral / Q000097:blood*; D012189:Retrospective Studies; D012254:Ribavirin / Q000627:therapeutic use; D015996:Survival Rate; D019562:Viral Load; D055815:Young Adult
chemical_list: D000998:Antiviral Agents; D012367:RNA, Viral; D011092:Polyethylene Glycols; D012254:Ribavirin; D007372:Interferons