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Blood, 15 September 2001, Vol. 98, No. 6, pp. 1836-1841
HEMOSTASIS, THROMBOSIS, AND VASCULAR BIOLOGY
The natural history of chronic hepatitis C in a cohort of
HIV-negative Italian patients with hereditary bleeding
disorders
Massimo Franchini,
Gina Rossetti,
Annarita Tagliaferri,
Franco Capra,
Elena de Maria,
Corrado Pattacini,
Giuseppe Lippi,
Giuliana Lo
Cascio,
Marzia de Gironcoli, and
Giorgio Gandini
From the Servizio di Immunoematologia e Trasfusione,
Centro Emofilia, and Servizio di Microbiologia, Azienda Ospedaliera di
Verona, Verona, Italy; Servizio di Immunoematologia e Trasfusione,
Centro Emofilia, Ospedale S. Chiara, Trento, Italy;
5a Divisione Medica, Centro Emofilia, Azienda
Ospedaliera di Parma, Parma, Italy; Medicina Interna A, Dipartimento di
Medicina e Sanità Pubblica and Istituto di Chimica e Microscopia
Clinica, Università di Verona, Verona, Italy.
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; range, 15-71) affected by hereditary bleeding disorders who have been infected with HCV for 15 to 34 years
(median, 25.1). All these patients were infected before the mid 1980s
because of non-virally inactivated pooled blood products. Fourteen
patients (13.7%) were HCV-RNA negative with no signs of liver disease
and were considered to have cleared the virus. Eighty-eight patients
(86.3%) were HCV-RNA positive. The HCV genotype distribution was 1a in
20.5%, 1b 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, symptomatic in 4 cases, and associated with liver
disease and with genotype 1. Among the 88 HCV-RNA-positive patients,
15 (17.0%) had normal alanine aminotransferase levels and abdominal
ultrasound, 61 (69.3%) had nonprogressive chronic hepatitis, and 12 (13.7%) had severe liver disease (6 [6.9%] liver cirrhosis, 4 [4.5%] hepatic decompensation, and 2 [2.3%] hepatocellular
carcinoma) 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 advanced liver disease. The results
confirm the slow progression of HCV infection in HIV-negative hemophiliacs.
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