Hepatitis C Virus in patients with inherited bleeding disorders

Patients with inherited bleeding disorders have a high prevalence of coinfection with hepatitis C virus (HCV) and HIV. HCV-related liver disease remains a significant contributor to morbidity and mortality in this patient population, and the rate of liver disease progression may be accelerated by HIV coinfection. Although treatment for HCV monoinfection has achieved relative success in other patient cohorts, rates of sustained virologic response for both monoinfected and HCV/HIV-coinfected hemophiliacs lag behind. Few studies have investigated the mechanisms underlying these lower response rates. This article describes the burden of HCV infection in hemophiliacs, explores viral and host factors that may mediate liver disease progression and response to treatment, outlines the role of biopsy in patients with bleeding disorders, and summarizes HCV treatment trials to date.