Prevalence of Hepatitis C Infection and Virus Clearance in Patients with Hemophilia

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 4706-4706
Author(s):  
Kamila Izabela Cisak ◽  
Jianmin Pan ◽  
Shesh Nath Rai ◽  
Patricia Ashby ◽  
Vivek R. Sharma
Keyword(s):  
Viral Load ◽  
Hepatitis C ◽  
Factor Viii ◽  
The United States ◽  
Treatment Center ◽  
Clotting Factor ◽  
Hepatitis C Infection ◽  
Clotting Factors ◽  
Virus Clearance ◽  
Viii And Ix

Abstract Introduction Hemophilia A and B are hereditary genetic disorders caused by deficiency of clotting factor VIII and IX respectively. Infusions of clotting factors constitute the mainstay of treatment. Before availability of recombinant factor VIII and IX, patients with hemophilia received products derived from human plasma and were at risk of blood-borne infections exposure. Since then, ongoing advances have yielded not only safer recombinant clotting factors but also effective treatment of infections. Hepatitis C infection and its complications constitute a common cause of morbidity and mortality in older hemophilia patients. In the last few years, FDA approved various antiviral medications which allow achievement of sustained virologic response and even cure hepatitis C infection. Goal of our study is to show prevalence of hepatitis C infection and virus clearance at our hemophilia treatment center. Methods We performed retrospective chart review of patients followed at a single hemophilia treatment center in the United States. We included 59 patients with factor VIII or IX deficiency, age 30 and older, followed in clinic between 2005 and 2014. Patients with acquired hemophilia were excluded from study. Data was collected from physician notes and laboratory tests results which included hepatitis C antibodies and viral load. Results 39 (66.1%) patients had history of hepatitis C infection. 21 (35.6%) patients had detectable hepatitis C viral load [95% CI 0.24-0.49] while 18 (30.5%) patients cleared the virus [95% CI 0.19-0.44]. Conclusions Our study showed that 66.1% of hemophilia patients followed at our institution had current or past hepatitis C infection. More than half of them were virus carriers during their last viral load check. Many of them had refused interferon-based treatment due to the requirement of being on it for long duration and concerns about side effects. Others had received the treatment but failed it. This constituted as much as 35.6% of hemophilia patients at our hemophilia treatment center. Availability of the newer antiviral agents that are better tolerated and yield high cure rates provide an opportunity to further reduce the disease burden in these patients. Disclosures No relevant conflicts of interest to declare.

scholarly journals Effect of danazol on clotting factor levels, bleeding incidence, factor infusion requirements, and immune parameters in hemophilia

Blood ◽  
1986 ◽  
Vol 68 (3) ◽  
pp. 673-679 ◽  
Author(s):  
P Saidi ◽  
BZ Lega ◽  
HC Kim ◽  
K Jr Raska
Keyword(s):  
Factor Viii ◽  
Plasma Levels ◽  
Fibrinolytic Activity ◽  
Clotting Factor ◽  
Clotting Factors ◽  
Double Blind ◽  
Immune Parameters ◽  
Plasma Factor ◽  
Viii And Ix ◽  
Mucosal Bleeding

Abstract Several recent studies have reported conflicting results on the effectiveness of danazol, an attenuated androgen, in raising plasma levels of clotting factors VIII and IX in patients with hemophilia. We undertook a randomized, double-blind cross-over trial using 8 weeks' administration of danazol (D), 600 mg/d, and 8 weeks' administration of placebo (P) separated by 2 weeks of rest in 12 patients with hemophilia A and four patients with hemophilia B. Plasma factor VIII and IX levels, frequency and type of bleeding episodes, amount of factor concentrate infused, fibrinogen, fibrinolysis assays, antithrombin III, liver function, and immune parameters were followed. During the danazol phase a minimal increase was noted in the average clotting factor levels, an increase that, although statistically significant, was of hemostatically marginal magnitude. Significant increases in protein C and plasminogen levels, however, were observed during the danazol period, suggestive of danazol-mediated enhanced fibrinolysis. Clinically, bleeding frequency was significantly increased, and more clotting factor was consumed during the danazol period. Furthermore, eight episodes of hematuria and oral mucosal bleeding was reported during the danazol phase in contrast to only one episode of hematuria during the placebo phase, consistent with an enhancement of fibrinolytic activity with danazol. We conclude that danazol does not have a hemostatically significant effect on plasma levels of factor VIII and IX but may be associated with enhancement of fibrinolytic activity, resulting in increased bleeding frequency and requiring more clotting factor infusions. Therefore, danazol is not a viable alternative in the treatment of hemophilia.

scholarly journals Effect of danazol on clotting factor levels, bleeding incidence, factor infusion requirements, and immune parameters in hemophilia

Blood ◽  
1986 ◽  
Vol 68 (3) ◽  
pp. 673-679
Author(s):  
P Saidi ◽  
BZ Lega ◽  
HC Kim ◽  
K Jr Raska
Keyword(s):  
Factor Viii ◽  
Plasma Levels ◽  
Fibrinolytic Activity ◽  
Clotting Factor ◽  
Clotting Factors ◽  
Double Blind ◽  
Immune Parameters ◽  
Plasma Factor ◽  
Viii And Ix ◽  
Mucosal Bleeding

Several recent studies have reported conflicting results on the effectiveness of danazol, an attenuated androgen, in raising plasma levels of clotting factors VIII and IX in patients with hemophilia. We undertook a randomized, double-blind cross-over trial using 8 weeks' administration of danazol (D), 600 mg/d, and 8 weeks' administration of placebo (P) separated by 2 weeks of rest in 12 patients with hemophilia A and four patients with hemophilia B. Plasma factor VIII and IX levels, frequency and type of bleeding episodes, amount of factor concentrate infused, fibrinogen, fibrinolysis assays, antithrombin III, liver function, and immune parameters were followed. During the danazol phase a minimal increase was noted in the average clotting factor levels, an increase that, although statistically significant, was of hemostatically marginal magnitude. Significant increases in protein C and plasminogen levels, however, were observed during the danazol period, suggestive of danazol-mediated enhanced fibrinolysis. Clinically, bleeding frequency was significantly increased, and more clotting factor was consumed during the danazol period. Furthermore, eight episodes of hematuria and oral mucosal bleeding was reported during the danazol phase in contrast to only one episode of hematuria during the placebo phase, consistent with an enhancement of fibrinolytic activity with danazol. We conclude that danazol does not have a hemostatically significant effect on plasma levels of factor VIII and IX but may be associated with enhancement of fibrinolytic activity, resulting in increased bleeding frequency and requiring more clotting factor infusions. Therefore, danazol is not a viable alternative in the treatment of hemophilia.

Antibody to Hepatitis G Mrus after a Vapour-Heated Factor Vlll Goncentrate

1990 ◽  
Vol 64 (02) ◽  
pp. 232-234 ◽  
Author(s):  
P M Mannucci ◽  
A R Zanetti ◽  
M Colombo ◽  
A Chistolini ◽  
R De Biasi ◽  
...  
Keyword(s):  
Hepatitis C Virus ◽  
Hepatitis C ◽  
Hepatitis B ◽  
Factor Viii ◽  
Alanine Aminotransferase ◽  
Household Contact ◽  
Clotting Factor ◽  
Double Infection ◽  
Marked Elevation ◽  
Clotting Factor Concentrates

SummaryTo evaluate whether or not clotting factor concentrates exposed to virucidal procedures transmitted hepatitis C, sera obtained in 1984–1986 from 27 previously untreated hemophiliacs infused with a vapour-heated factor VIII concentrate were tested retrospectively for the antibody to the hepatitis C virus (anti- HCV). A 2-year-old hemophiliac, negative for anti-HCV before administration of concentrate, seroconverted at week 12 and remained anti-HCV positive thereafter. Both his parents were anti-HCV negative and he had no other household contact. The patient had also become HBsAg positive at week 8 and had at the same time a marked elevation of alanine aminotransferase. His double infection with the hepatitis B and C viruses indicates that hot vapour was not completely effective in inactivating these viruses.

Hepatitis C and Pasteurised Factor VIII and IX Concentrates

1995 ◽  
Vol 73 (04) ◽  
pp. 736-737 ◽  
Author(s):  
D Klarmann ◽  
W Kreuz ◽  
G Auerswald ◽  
K Auberger ◽  
H Rabenau ◽  
...  
Keyword(s):  
Hepatitis C ◽  
Factor Viii ◽  
Viii And Ix

scholarly journals 293. Hepatitis C is now a Millennial Disease in Response to the Opioid Crisis: A Demographic Shift in Hepatitis C Infection

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S159-S159
Author(s):  
Michelle Rose ◽  
John Allen Myers ◽  
Nicholas Ryan ◽  
Alissa Prince ◽  
Morgan Talbot ◽  
...  
Keyword(s):  
Hepatitis C ◽  
Baby Boomers ◽  
Infected Individual ◽  
The United States ◽  
Hcv Infection ◽  
Demographic Shift ◽  
Hepatitis C Infection ◽  
Opioid Crisis ◽  
Chronic Hcv ◽  
Over Time

Abstract Background Previous research has shown millennials represent the fastest growing generation for those infected with the hepatitis C virus (HCV). Millennials are also a key driver in the opioid crisis, particularly in states of the Appalachian region including Kentucky. Despite research demonstrating a change in prevalence from baby boomers (born 1945–1965) to millennials (born 1980–1995), large representative studies providing evidence of the magnitude of this demographic shift are lacking in the United States. Our objective was to assess trends of HCV infection since 2016 in a large healthcare system located in an area of high prevalence of opioid use and HCV infection. Methods All individuals were screened for HCV infection in 2016, 2017, and 2018 within Norton Healthcare per standard risk-based criteria (e.g., injection drug users, baby boomers, etc.) as recommended by CDC, except for pregnant women who were universally screened since 2016. We tested for demographic shifts over time using longitudinal and time series analyses techniques Results A total of 86,243 individuals were screened for HCV infection from 2016 to 2018. Of those, 2,615 (3.0%) individuals screened positive for chronic HCV. The average age of those infected significantly decreased by an average of 3.7 years annually (from 47.3 years in 2016 to 39.9 years in 2018, P < 0.001). We forecast a plateau near the age of 28 years will be observed in just over 7 years. In addition, the proportion of millennials increased over time (33.6% in 2016, 42.4% in 2017 and 51.4% in 2018, P < 0.001), while baby boomers significantly decreased over time (44.0% in 2016, 38.8% in 2017, and 29.3% in 2018, P < 0.001). Lastly, over time, those with chronic HCV were more likely to be male (increasing from 49.6% to 54.4%, P = 0.008) and Hispanic (increasing from 1.6% to 17.7%, P < 0.001) Conclusion Our results suggest that HCV infection has become a predominately millennial disease, skipping a generation. These results correlate with trends seen with the opioid epidemic, which is driven by millennials. We conclude that the opioid crisis has led to a drastic demographic shift, and currently the typical HCV-infected individual is a younger male. Without interventions, this trend will continue for over seven years, plateauing near the demarcation of millennials and generation Z Disclosures All authors: No reported disclosures.

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