The natural history of chronic hepatitis C in a cohort of HIV-negative Italian patients with hereditary bleeding disorders

This study looked at 102 anti-hepatitis C virus (HCV)-positive, hepatitis B virus (HBV)-negative, and HIV-negative patients (median age, 45.1 years; r ange, 15-71) affected by hereditary bleeding disorders who have been infect ed with HCV for 15 to 34 years (median, 25.1). All these patients were infe cted before the mid 1980s because of non-virally inactivated pooled blood p roducts. Fourteen patients (13.7%) were HCV-RNA negative with no signs of l iver disease and were considered to have cleared the virus. Eighty-eight pa tients (86.3%) were HCV-RNA positive. The HCV genotype distribution was 1 a in 20.5%, 1 b in 36.4%, 2 in 17.0%, 3 in 15.9%, 4 in 3.4%, and mixed in 6. 8% of cases. Twenty-four patients (23.5%) had serum cryoglobulins, symptoma tic in 4 cases, and associated with liver disease and with genotype 1. Amon g the 88 HCV-RNA-positive patients, 15 (17.0%) had normal alanine aminotran sferase levels and abdominal ultrasound, 61 (69.3%) had nonprogressive chro nic hepatitis, and 12 (13.7%) had severe liver disease (6 [6.9%] liver cirr hosis, 4 [4.5%] hepatic decompensation, and 2 [2.3%] hepatocellular carcino ma) after a follow-up period of 25 years. There were 3 (3.4%) liver-related deaths. HCV genotype 1, patient's age at evaluation, duration of infection , and severity of congenital bleeding disorder were associated with more ad vanced liver disease. The results confirm the slow progression of HCV infec tion in HIV-negative hemophiliacs.