INVESTIGATION OF CHRONIC HEPATITIS-C INFECTION IN INDIVIDUALS WITH HEMOPHILIA - ASSESSMENT OF INVASIVE AND NONINVASIVE METHODS

Hepatitis C virus (HCV) infection is the major cause of chronic liver disease in individuals with haemophilia. A wide spectrum of disease se verity is found in this group, ranging from mild hepatitis to cirrhosi s. We have studied a cohort of 87 anti-HCV positive haemophiliacs who have been infected with HCV for 10-25 years and assessed the relative value of invasive and non-invasive methods of evaluating liver disease . The severity of liver disease was assessed using ultrasound scan (n = 77), upper GI endoscopy (n = 50), laparoscopic liver inspection (n = 33) and liver biopsy (n = 22). Invasive investigations were performed without any significant bleeding complications. Evidence of severe li ver disease was found in approximately 25% of patients, There was agre ement between the severity of liner histology and the information deri ved from the laparoscopic liver inspection, endoscopy and ultrasound i n 86%. Co-infection with HIV was significantly associated with more se vere liver disease (P = 0 . 006). This study provides further evidence that liver disease is emerging as a major complication in haemophilia cs and severe liver disease is more common in those co-infected with H IV, We have shown the potential value of laparoscopic liver inspection , in combination with endoscopy and ultrasound, in staging the extent of liver disease, and suggest that most patients may be managed withou t resorting to liver biopsy.