Maor Y, Bashari D, Kenet G, Lalezari S, Lubetsky A, Luboshitz J, Schapiro J M, Avidan B, Bar-Meir S, Martinowitz U
Department of Gastroenteroloy and Hepatology, Sheba Medical Center, Tel-Hashomer, Israel.
Haemophilia. 2006 Jan;12(1):68-74. doi: 10.1111/j.1365-2516.2006.01178.x.
Haemophilia patients who received non-virucidally treated large pool clotting factors before 1987 have a high rate of chronic hepatitis C viral infection (HCV). Some patients are coinfected with HIV. Haemophilia patients and other coagulation disorders were treated at one centre since the beginning of the 1970, and the Israeli National Hemophilia Center (INHC) was officially founded in 1987. To characterize patients with HCV as well as patients with HCV/HIV coinfection at the INHC. Patients with haemophilia and other coagulation disorders positive for HCV antibodies were evaluated between 2001 and 2004. Demographic data, type and severity of coagulation disorder, frequency of coagulation factor usage and treatment with concentrated clotting factors prior to 1987 were recorded. Liver enzymes, viral load, genotype and data supporting advanced liver disease were evaluated. About 179 of 239 haemophilia patients (75%) tested positive for anti-HCV antibodies. Our cohort consisted of 165 patients in whom clinical, biochemical and virological data were available. About 117 patients had active HCV infection with HCV-RNA-positive, and 27 were HCV/HIV coinfected. Twenty-one patients (13%) persistently tested HCV-RNA-negative, hence were considered to clear their HCV infection. There was no former USSR immigrants among HCV/HIV coinfected compared with HCV-infected or HCV-RNA-negative groups (0 vs. 30% and 38%, respectively; P < 0.001). HCV-RNA-negative patients used concentrated coagulation factor less frequently than HCV or HCV/HIV-infected patients (48% vs. 73%; P = 0.023, and 48% vs. 74%; P = 0.043, respectively). The use of concentrated clotting factors before 1987 was significantly more frequent in HCV/HIV than in either HCV-infected or HCV-RNA-negative patients (96% vs. 49% and 48%, respectively; P < 0.001). Compared with HCV/HIV subjects, patients with HCV monoinfection were characterized by a higher proportion of infection with genotype 1 (80% vs. 61%; P = 0.027). The rate of persistently normal liver enzymes in these patients was higher (24% vs. 7%; P = 0.05) than in the HCV/HIV-coinfected patients. Advanced liver disease was significantly more common in patients with HCV/HIV-coinfection than in HCV-monoinfected patients (11% vs. 3%; P = 0.045). The majority of haemophilia patients are infected with HCV. Viral clearance occurred in a minority of these patients. HCV monoinfected and HCV/HIV coinfected differ clinically and prognostically.
1987年以前接受过非病毒灭活处理的大剂量凝血因子治疗的血友病患者，慢性丙型肝炎病毒（HCV）感染率很高。一些患者同时感染了HIV。自20世纪70年代初以来，血友病患者和其他凝血障碍患者在一个中心接受治疗，以色列国家血友病中心（INHC）于1987年正式成立。目的是对INHC的HCV患者以及HCV/HIV合并感染患者进行特征描述。2001年至2004年期间，对HCV抗体阳性的血友病和其他凝血障碍患者进行了评估。记录了人口统计学数据、凝血障碍的类型和严重程度、凝血因子使用频率以及1987年以前使用浓缩凝血因子的治疗情况。评估了肝酶、病毒载量、基因型以及支持晚期肝病的数据。239名血友病患者中约179名（75%）抗HCV抗体检测呈阳性。我们的队列由165名患者组成，他们有临床、生化和病毒学数据。约117名患者有活动性HCV感染，HCV-RNA呈阳性，27名患者为HCV/HIV合并感染。21名患者（13%）HCV-RNA持续检测为阴性，因此被认为清除了HCV感染。与HCV感染组或HCV-RNA阴性组相比，HCV/HIV合并感染组中没有前苏联移民（分别为0%对30%和38%；P<0.001）。HCV-RNA阴性患者使用浓缩凝血因子的频率低于HCV或HCV/HIV感染患者（分别为48%对73%；P=0.023，以及48%对74%；P=0.043）。1987年以前使用浓缩凝血因子的频率在HCV/HIV组中显著高于HCV感染组或HCV-RNA阴性组（分别为96%对49%和48%；P<0.001）。与HCV/HIV患者相比，HCV单一感染患者的特点是基因型1感染比例较高（80%对61%；P=0.027）。这些患者肝酶持续正常的比例高于HCV/HIV合并感染患者（24%对7%；P=0.05）。晚期肝病在HCV/HIV合并感染患者中比HCV单一感染患者更常见（11%对3%；P=0.045）。大多数血友病患者感染了HCV。这些患者中少数发生了病毒清除。HCV单一感染和HCV/HIV合并感染在临床和预后方面存在差异。
