THE PROGRESSION OF HCV-ASSOCIATED LIVER-DISEASE IN A COHORT OF HEMOPHILIC PATIENTS

We have studied morbidity and mortality related to hepatitis C virus i nfection in haemophilic patients treated at our centre. 11/255 HCV ser opositive patients have developed hepatic decompensation. 20 years aft er first exposure to lyophilized clotting factor concentrate the risk of hepatic decompensation is estimated to be 10.8% (95% CI 3.8-17.8%). There is a significantly increased risk associated with HIV infection , and also with increased age. For HN seropositive patients the rates of decline in CD4 lymphocyte count and the development of p24 antigena emia are significant risk factors for hepatic decompensation. Cirrhosi s was seen in 9/19 HIV seropositive patients at post mortem. There was an association of cirrhosis with increased age but not with CD4 count , p24 antigenaemia, or AIDS. In conclusion, HCV infection is associate d with serious liver disease in haemophilic patients, but so far this has been restricted to a minority of those at risk. HIV coinfection ac celerates progression to hepatic decompensation, and we speculate that this is probably due to enhanced HCV replication in the presence of i mmune deficiency.