Hepatitis C viral load, genotype and histological severity in patients with bleeding disorders

We report the relationship between hepatitis C virus (HCV) titre, liver histology and HCV genotype in patients with bleeding disorders. One hundred and thirty-two RIBA-2-positive patients, including 56 who were also HIV positive, were identified at our centre. Fifty of these patients, including nine who were HIV infected, underwent percutaneous liver biopsy. Liver histology was assessed using a modified histological activity index (HAI). Qualitative serum HCV PCR was positive in 87 (87%) of the 101 patients tested including 43 of 50 biopsied patients. HCV RNA titres, measured by quantitative PCR, were significantly higher in HIV-positive patients compared with HIV-negative patients (P < 0.05) but were not related to HAI, mean factor concentrate usage, duration of HCV infection or HCV genotype. There was no relationship between HCV genotype and HAI. Qualitative HCV PCR was positive in 30 of 43 liver biopsies tested. Biopsy PCR-positive and -negative cohorts were not distinguished by HAI or serum HCV titre. We conclude that although serum HCV PCR is useful in confirming the presence of HCV infection in patients with bleeding disorders, little meaningful information concerning the severity of the disease can be obtained from serum HCV quantification.     

Viral hepatitis in Nigeria--sickle-cell disease and commercial blood donors

Hepatitis virus infection is a major cause of morbidity andmortality in sub-Saharan Africa. The high prevalence of hepatitisB virus (HBV) infection in this region is thought to be dueto horizontal transmission during childhood. Hepatitis C virus(HCV) infection is also quite prevalent in Africa, but the epidemiologyof this infection has yet to be defined. We examined the prevalenceof HBV and HCV serological markers in 220 patients attendingsickle-cell anaemia clinics in Benin City, Nigeria, in 228 healthylocals, and in 104 local commercial blood donors, to test thehypothesis that patients requiring blood transfusion from unscreenedcommercial blood donors (in this area of high prevalence forviral hepatitis) are at great risk for the acquisition of post-transfusionhepatitis. Overall, the frequency of hepatitis viraemia in blooddonors was high (14% of donors were either HbsAg or anti-HCVpositive). Evidence of previous exposure to HBV was common inall three study groups. Risk of HBV infection for sickle-cellpatients was not clearly increased by blood transfusion. HCVexposure, however, appears related to transfusion requirement,and all Western-blot-confirmed anti-HCV-positive sicklers hada history of blood transfusion. Screening of blood productsin sub-Saharan Africa is unlikely to reduce prevalence of HBV,but may minimize the risks of HCV transmission.     

UKHCDO guidelines on the management of HCV in patients with hereditary bleeding disorders 2011

Summary. Chronic HCV infection continues to be of significant clinical importance in patients with hereditary bleeding disorders. This guideline provides information on the recent advances in the investigation and treatment of HCV infection and gives GRADE system based recommendations on the management of the infection in this patient group.     

Vasculitis in Primary Biliary Cirrhosis--Response to Prednisolone

Immunosuppressive doses of prednisolone were used to treat severevasculitis in two patients with early primary biliary cirrhosis.Liver-specific blood tests of both patients returned to normal.The response of both the vasculitis and liver disease is discussedand the literature is reviewed.