The Natural History of Hepatitis C Viral Infection and HCV Genotypic Distribution in Thai Hemophilia Patients at Siriraj Hospital
Chuenjitkulthaworn T, MD1, Bandidniyamanon W, MEcon3, Ruchutrakool T, MD2, Chainuvati S, MD3
Affiliation : 1 Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand 2 Division of Hematology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand 3 Division of Gastroenterology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Background : Hemophilia patients are at risk of hepatitis C viral infection (HCV) from blood transfusions, which can often lead to
chronic hepatitis C (CHC). Patients are often excluded from HCV treatments due to the risk of bleeding from a liver biopsy. CHC
patients should have access to HCV treatment in Thailand. However, data on HCV in Thai hemophilia patients are limited.
Objective : To study the genotypic and disease progression of chronic HCV infection in hemophilia patients.
Materials and Methods : All hemophilia patients registered at Siriraj Hospital were screened and recruited for the study. Chronic
HCV patients were evaluated for liver tests, HCV viral load, genotype and liver stiffness (LS) measurement by transient elastography,
and imaging studies.
Results : Of 89 hemophilia patients in hospital database during the study period, 21 patients died, 7 patients had negative anti-HCV,
3 patients had co-infection and 22 patients refused to participate. Hence, 36 male patients signed informed consent, of those, 29
patients had positive anti-HCV (80.6%). Genotype 3a was the most common (42.8%), followed by genotype 1a (28.5%). The mean
HCV viral load was 2,416,722 IU/ml. LS were measured on 28 patients (96.6%). Median value of LS was 6.0 kPa (range 4.3 to 31.2).
In cirrhosis group (n = 5), the mean LS was 26.3 kPa (range 4.3 to 31.2), which was significantly different from non-cirrhosis group
(5.3 [range 4.3 to 8.1] kPa, p = 0.008. The median LS value in long-term transfusion time (>30 years) is higher than the group with
a transfusion time of <30 years (6.8 vs. 4.8 kPa, p = 0.025). Three patients were successfully treated and achieved sustained virological
response.
Conclusion : The most common HCV genotype in Thai hemophilia patients was genotype 3a. LS correlated with the exposure time
during blood transfusion.
Keywords : Chronic hepatitis C, Hemophilia, Transient elastrography
