Prevalence of hepatitis c in adults with sickle cell disease

Hepatitis C (HCV) is a common viral infection that can lead to chronic hepatitis, liver cirrhosis and hepatocellular carcinoma. This chronic disease is transmitted by various routes, with blood product transfusions being the most frequent (Risk is: 1/100,000 unit transfused) and is known to be more common in minority populations (3.2% African Americans). It is responsible for 8,000-10,000 deaths/year. We have been testing our adult sickle cell disease population since 1994 for the prevalence of the hepatitis C virus antibody. At the present 178 patients have been tested out of our current 310 active patient population. We have found 17 patients with a reactive Hepatitis C test. The clinical and laboratory characteristic of this group is as follows: Liver Functions test (LFT'S): ↑ ALT/AST 5/ 17 ↑ AST only 3 / 17 ↑ ALT only 1 / 17 ML ALT/AST 8 / 17 Transfusion History: ≥ 10 units PRBC/ lifetime 9 / 17 ≤ 9 unit PRBC/ lifetime 2/17 Not sufficient data 6/17 Hepatitis C virus load (PCR) > 2,000 copies 4 / 17 Not sufficient data 13/17 4 out of 17 patient have started treatment for Hepatitis C with Interferon ot and Ribavirin, with the goal of virus eradication and reduction of liver cell damage and inflamation and aiming for prevention of progresion to future complications. 1 patient successfully finished therapy with normalization of her previously elevated LFT'S and HCV virus load quantification of < 2,000. 2 other patients are still undergoing treatment, both of them have achieved normalization of previously increased LFT's and one has also virus load quantification of < 2,000. Lastly, one patient was unable to tolerable treatment and presented with complications such as hemolytic anemia, malaise and failure to thrive after 2 months of therapy. Although our experience with Hepatitis C and Sickle cell disease is limited, the above data suggest that further efforts need to be applied to identify and test individuals with Sickle cell disease that have received blood products through transfusions before 1992 thus being at risk for Hepatitis C and its complications and evaluated for consideration of treatment if infected with HCV.

Duke Scholars

Author Laura Martina De Castro Medicine, Hematology