A combined management protocol for patients with coagulation disorders infected with hepatitis C virus


Dr J. T. Wilde Haemophilia Unit, Queen Elizabeth Hospital, Edgbaston, Birmingham B15 2TH.


The case notes of 394 adults with bleeding disorders registered at our centre together with those of the 72 patients who had died since 1971 were reviewed. 36/72 deceased patients had evidence of HCV infection. Liver decompensation was present at time of death in six. 274 (70%) of the currently registered patients had received factor concentrate or cryoprecipitate and 174 of these were screened for HCV infection. 76% of tested patients were RIBA positive. 87% of RIBA-positive patients were RT-PCR positive. 50 RIBA-positive patients, including nine who were HIV infected, have undergone percutaneous liver biopsy following appropriate factor infusion with no complication. The biopsy was assessed using a Histological Activity Index (HAI) ranging from 0 to 13. Patients with HAI ≥6 were offered treatment with interferon. Patients with HAI<6 were followed up with a view to re-biopsy in 2–3 years to assess progression. The median HAI was 4.5 (range 0–10) with HAI ≥6 in 13 cases (27%). HAI was not correlated with duration of infection, haemophilia severity, RT-PCR status, HIV status or HCV genotype. Liver biopsy, a safe procedure in our hands, is an important investigation in HCV-infected patients to assess suitability for interferon therapy.