ASSESSMENT AND TREATMENT OF LIVER-DISEASE IN JAPANESE HEMOPHILIA PATIENTS

We studied the prevalence of the hepatitis C virus (HCV), human immuno deficiency virus (HIV) and GB virus C or hepatitis G virus (GBV-C/HGV) , and characteristics of infections in Japanese haemophilia patients. Haemophilia patients were highly infected with HCV (88.2%) because of frequent use of unheated blood concentrates. Analysis for HCV genotype s revealed characteristics of HCV infection in haemophilia patients. J apanese haemophilia patients were highly infected with rare genotypes in Japan: genotype la (26.5%), genotype 3 (14.5%) and genotype 4 (2.4% ). HIV infection was observed in 32.3% of haemophilia patients. HCV qu asispecies (clones) and direct sequencing were investigated in patient s with a single HCV genotype in the hypervariable region 1 of HCV, whi ch resulted in a high degree of diversity. This indicates that even a single genotype of HCV might have multiple origins. GBV-C/HGV infectio n was noted in 20.9% of Japanese haemophilia patients. Over 40 haemoph ilia patients with chronic hepatitis C have been treated with interfer on alpha for 6 months at total doses of 480-720 million units. About 3 8% showed clearance of HCV RNA from serum. Six patients with HIV infec tion were included in the study and they did not show eradication of H CV from the serum. This might derive from that they had high serum HCV RNA titers and genotype la or Ib. Histologic assessment was performed in 36 haemophilia patients with HCV. No case showed a histologically normal liver. Hepatic fibrosis in the biopsy specimens was classified into five stages of fibrosis and compared with serum hepatic fibrosis markers. Serum hyaluronic acid mostly correlated with hepatic fibrosis (r = 0.78, P < 0.0001) followed by type IV collagen (r = 0.38, P < 0. 05). This suggests that estimation of serum fibrosis markers might be substituted for liver biopsy in haemophilia patients.