Clinical

HBV infection predicts clearance of HCV in hemophiliacs

Last Updated: 2006-02-28 17:58:05 -0400 (Reuters Health)

By Anthony J. Brown, MD

NEW YORK (Reuters Health) - Consistent with what has been seen in other patient groups, chronic infection with hepatitis B virus (HBV) raises the odds of clearing hepatitis C virus (HCV) in patients with hemophilia, according to a report in the February 1st issue of Blood. HCV infection early in life or after 1983 were also significant predictors of clearance, the report indicates.

Hemophiliacs are at high risk for HCV infection, but roughly 20% of infected hemophiliacs will spontaneously clear the virus. "It is important to identify these patients because they essentially have zero risk of developing complications from the infection," senior author Dr. James J. Goedert, from the National Institutes of Health in Rockville, Maryland, told Reuters Health.

The new study involved 712 HCV-seropositive subjects with hemophilia. Of these, 192 (27%) eventually had persistently undetectable HCV RNA in their plasma.

On multivariate analysis, chronic HBV infection was associated with a ninefold increased chance of HCV clearance. HCV infection at younger than 2 years of age or after 1983 also increased the odds of viral clearance, the report indicates. African ancestry reduced the odds of clearance but not significantly.

Resolved HBV infection, coagulopathy type and severity, the clotting factors received, and gender were not significant correlates of HCV clearance, the report indicates.

Regarding the effect of HBV coinfection, Dr. Goedert noted that "individual cells in the liver could potentially be infected with both viruses, but the cell may only support replication of one of these viruses." Therefore, the presence of HBV in cells throughout the liver may not allow for HCV replication, he added.

Young children with hemophilia may be better able to clear HCV than their older counterparts because they can launch a more robust immune response, Dr. Goedert said. Another possibility is that because of their small size, they receive a smaller amount of plasma products, which in turn means a smaller inoculum of HCV, he added.

The association with infection after 1983 probably relates to the introduction of donor screening and virus inactivation around this time, Dr. Goedert said. Infections prior to 1983 were more likely to be repeat infections, which are more difficult to clear, whereas those after 1983 were more likely to be new infections, which are easier to clear, he added.

Blood 2006;107:892-897.