HEPATIS IN PWH
HEPATITIS IN PWH
Persons with Hemophilia (PWH) are at higher risk of Hepatitis B (HBV) and Hepatitis C (HCV), especially if they receive multiple transfusions or clotting factor treatments. These infections can lead to serious liver complications and increase morbidity and mortality.
Magnitude of the Problem
In Pakistan, HBV affects 5–10% of multiply transfused PWH.
HCV affects 30–35% of multiply transfused PWH.
Both infections contribute to significant health risks and complications.
Diagnosis
Screening and diagnostic tests include:
HBV antigen (Ag), HCV antibody – for initial screening
IgM core antibody – indicates acute HBV infection
Anti-HBV antibody – protective antibody
HBeAg, HBV DNA PCR, HCV RNA PCR – done when considering antiviral therapy
Types of Liver Disease
Acute Infection:
Acute hepatitis: Illness <6 months
Fulminant hepatic failure: rapid liver failure within 6 weeks
Subacute hepatic failure: develops ~8 weeks after symptoms
Chronic Infection:
Chronic hepatitis: lasts >6 months
Cirrhosis: liver fibrosis and nodules
Hepatocellular carcinoma: liver cancer detected by histology and alpha-fetoprotein
Antiviral Treatment
Chronic Hepatitis / Cirrhosis:
Antiviral therapy is recommended for replicative HBV (HBeAg+ / HBV DNA+) and HCV RNA+ patients
Treatment aims to stop viral replication and reduce risk of liver cancer
Acute Hepatitis:
Acute HBV: usually does not require antiviral therapy
Acute HCV: antiviral therapy is recommended if viremic
Common Drugs:
| Virus | Drug | Duration | Cost (approx 2003) |
|---|---|---|---|
| HBV | PEG Interferon α2A/B | 4 months | 2.1 lakhs |
| HBV | Interferon α2A/B | 4 months | 80,000 |
| HBV | Lamivudine | 6 months | 6,000 |
| HCV | PEG Interferon α2A/B | 4 months | 3.2 lakhs |
| HCV | Interferon α2A/B | 4 months | 80,000 |
| HCV | Ribavirin | 6 months | 50,000 |
Management of Complications
Portal Hypertension: Propranolol, endoscopic therapy, or shunt surgery
Fluid Overload (Ascites/Edema): Salt restriction, spironolactone
Hepatic Encephalopathy: Low protein diet if needed, lactulose, correct triggers (e.g., hypokalemia)
Liver Transplantation:
Recommended for severe liver failure
Transplanted liver produces missing coagulation factors, potentially curing Hemophilia
Vaccination & Diet
Hepatitis B vaccination is recommended for all PWH (check HBsAg first)
No vaccine is available for HCV
Normal diet is recommended; restrict salt only if fluid overload develops
Protein restriction only if mental status is affected