Five-Year Follow-up of Patients with Primary Antibody Deficiencies Following an Outbreak of Acute Hepatitis C

• Published in: Clinical immunology (Orlando, Fla.) Fla.), 2001-06, Vol.99 (3), p.320-324
• Main Authors: Chapel, H.M., Christie, J.M.L., Peach, V., Chapman, R.W.G.
• Format: Article
• Language: English
• Subjects: a-Interferon; Acute Disease; Adolescent; Adult; Aged; antibody deficiency syndromes; Biological and medical sciences; Child, Preschool; Disease Outbreaks; Female; Follow-Up Studies; Hepatitis C - epidemiology; Hepatitis C - immunology; Hepatitis C virus; Humans; immunoglobulins; Immunologic Deficiency Syndromes - etiology; Immunopathology; Immunotherapy (general aspects); Interferon-alpha - therapeutic use; interferons; Male; Medical sciences; Middle Aged; RNA, Viral - analysis; United Kingdom - epidemiology
• ISSN: 1521-6616; 1521-7035
• DOI: 10.1006/clim.2001.5036

This report is the 5-year follow-up of those 25 UK patients with primary antibody deficiencies infected with hepatitis C virus (HCV), type 1a, from one batch of contaminated anti-HCV-screened intravenous immunoglobulin in 1993–1994. Of these patients, who were reported previously (1, 2), 2 cleared HCV spontaneously, 18 received early interferon-α (IFN) treatment for 6 months, and 5 declined treatment or treatment was contraindicated. The clinical course of this cohortwas followed prospectively using serial standardized questionnaires. Seven patients (54% of those who had completed therapy) had a sustained response (normal transaminase levels, negative serum HCV RNA) for 5 years posttreatment. Eight patients died: 3 from decompensated cirrhosis, 2 from pneumonia but with evidence of liver failure, and 3 from unrelated causes. One further patient developed decompensated cirrhosis but was successfully transplanted. Seven patients remain chronically infected; only 1 patient is symptomatic but 1 further patient has evidence of progressive fibrosis on liver histology. In conclusion, within 5 years, rapid end-stage HCV liver disease has been seen in 6/25 (24%) patients. Seven patients, (54% of those fully treated) remain well after treatment, making 9/25 (36% of the cohort) clear of virus after 5 years. Those who completed early treatment with IFN had a relatively high sustained response rate compared to previous studies in both immunodeficient and immunocompetent patients.