Prevalance and treatment outcome of transfusion transmitted infections in hemophilia A

Objectives: Our objective was to highlight the occurrence of transfusion transmitted viral infections [TTI] even today and assess the treatment outcomes in those who were treated. Methods: Retrospective analysis of Hemophilia A database. HIV-1 and 2, HCV and HBV were tested by ELISA followed by further testing with Western Blot in retrovirus positive samples. Viral load testing by PCR was available since 2002. Results: Out of the total of 93 Hemophilia A patients registered at our institution since 1992, 17 (18.3%) were observed to have developed TTI's. Of these, 13(76.5%) had Anti-HCV positivity [6 HCV RNA PCR positive]; 2 (11.75%) were HIV-1 positive by western blot [both retrovirus RNA PCR positive]; and 2 (11.75%) were HBV positive [both HBV DNA positive]. Two of these patients were positive for all the three viruses together. Amongst the 6 HCV RNA PCR positive patients, 3 achieved a sustained virological remission[SVR] on treatment (2-Genotype 1a; 1 -Genotype 3), whereas, the remaining three did not qualify for treatment and are under close observation being asymptomatic with mildly elevated liver enzymes. The three treated patients received a combination of Ribavarin 1000 mg daily along with pegInterferon alpha 2a 180 lg/week for a period of 12- 18 months. Both the retrovirus positive cases, achieved SVR with undetectable retroviral RNA by PCR with standard HAART regimens. However, it took 32 and 27 months respectively to achieve SVR in these two patients. Both patients with HBV DNA positivity were also treated with either lamivudine or tenofovir as part of their HAART regimens and both had SVR. Conclusion: The cumulative prevalence of TTI's at our institution was 18.3% amongst the haemophilia A patients over the last 20 years. We report here SVR for HCV [3 ], retrovirus [2] and HBV [2] in the treated (100%) patients. Anti-HCV treatment was stopped 48 weeks after PCR negativity, whereas, anti-retrovirus treatment is ongoing according to the currently recommended treatment guidelines.