When to treat and the benefits of treating hepatitis C in patients with haemophilia.

Chronic hepatitis C (CHC), a curable infection, remains endemic worldwide. More than 90% of individuals with haemophilia have been infected with hepatitis C virus (HCV) mostly caused by transfusion with non-virucidally treated clotting factor concentrates. Relevant to haemophilics, the risk of cirrhosis with CHC infection is greatest in males, those who have been infected for a long time, consume alcohol regularly, and/or are co-infected with HIV. The cure rate, using the current standard therapy for CHC with pegylated-interferon-alpha given weekly and ribavirin daily, ranges from 43% to 65% in those infected with genotype 1 and 50-90% with genotype 2 and 3 infections. Eradication of hepatitis C in those co-infected with HIV is less in part because full dose therapy is poorly tolerated. Achieving a sustained virological response (SVR) prevents progression to cirrhosis and in those with established cirrhosis prevents liver failure, and reduces the risk if hepatocellular carcinoma, and the need for liver transplant. Novel treatment options now in development are predominantly focused on inhibitors of HCV-specific enzymes. The treatment paradigm for haemophilics infected with hepatitis C is that all should be assessed for treatment once a diagnosis of chronic hepatitis C is made in order to achieve the highest chance of an SVR, i.e. cure.