The natural history of HCV in a cohort of haemophilic patients infected between 1961 and 1985

Aim-This study describes the long term follow up of haemophilic patients in fected with hepatitis C virus (HCV) between 1961 and 1985. Methods-Clinical and treatment records from 310 patients with inherited coa gulation disorders treated with blood product before 1985 were reviewed. St andard survival analysis methods were used to model progression to liver fa ilure and death. Results-A total of 298/305 (98%) patients tested were anti-HCV positive. Tw enty seven (9%) individuals consistently HCV polymerise chain reaction nega tive were considered to have cleared the virus. By 1 September 1999, 223/31 0 (72%) were alive, 26 (8%) had died a liver related death, and 61 (20%) ha d died from other, predominantly human immunodeficiency virus (HIV) related , causes. Kaplan-Meier progression rates to death from any cause and liver related deaths 25 years after exposure to HCV were 47% (95% confidence inte rvals (CI) 34-60) and 19% (95% CI 10-27), respectively. After 13.3 years fr om 1985, by which time all patients had seroconverted to HIV, progression r ates to death from any cause and liver related deaths were, respectively, 8 % (95% CI 4-13) and 3% (95% CI 0.4-6) for those HIV negative, and 57% (95% CI 48-66) and 21% (95% CI 13-31) for those HIV positive (p=0.0001). Using C ox proportional hazard models, the adjusted relative hazard of death for in dividuals coinfected with HIV compared with those infected with HCV alone w as 19.47 (95% CI 9.22-41.10), 0.99 (95% CI 0.39-2.53), 3.47 (95% CI 1.40-8. 63), and 9.74 (95% CI 3.91-24.26) for the age groups at infection 10-19 yea rs, 20-29 years, and >30 years, respectively, compared with the age group < 10 years. The adjusted relative hazard for genotype 1 compared with other g enotypes was 2.7 (95% CI 1.36-5.15). Conclusions-While 25 year follow up of 310 haemophilic patients has shown t he potentially lethal combination of HIV and HCV coinfection, HCV singly in fected individuals show slow progression of liver disease.