Japanese researchers discovered that hepatitis C virus (HCV) infection in hemophilia did not increase the risk of hepatocellular carcinoma (HCC) if direct-acting antivirals facilitating a high rate of sustained virological response were administered, according to a study published in the Annals of Hepatology.

Furthermore, the eradication of HCV could, in fact, decrease liver-related diseases in patients with or without hemophilia. 

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The main reason the authors of this study planned to study HCV infection in patients with hemophilia was that existing literature suggests that hemophilia patients infected with HCV developed HCC at a younger age than patients without hemophilia. In addition, these 4 observations were made when comparing patients with and without hemophilia who were infected with chronic HCV: 

  • The duration of infection could be estimated more clearly from blood transfusion records in patients with hemophilia than in patients without hemophilia who do not require regular blood transfusions
  • A greater number of cases were noted among patients with hemophilia demonstrating coinfection with hepatitis B virus (HBV) or human immunodeficiency virus (HIV)
  • A greater number of cases were observed among patients with hemophilia showing mixed HCV genotype infection
  • Patients with hemophilia may demonstrate a higher HCV viral load.

The researchers conducted a study from January 2005 to December 2020 involving 850 patients with HCV who achieved sustained virological response through interferon antiviral therapy or direct-acting antivirals. The exclusion criteria were having HCC before antiviral therapy and having less than 1 year of follow-up. After applying the exclusion criteria, 699 patients remained. Of these, 78 patients had hemophilia (59 with type A, 19 with type B) and 621 patients did not have hemophilia. 

The results demonstrated that there were no differences in liver-related diseases or overall mortality between the hemophilia group and the non-hemophilia group. More significantly, the authors wrote, “In this study, we found no significant difference in the cumulative incidence of HCC after sustained virological response or the long-term prognosis in patients with and without hemophilia, suggesting that sustained virological response could reduce the rates of liver carcinogenesis and liver disease-related mortality in both groups of patients.”


Inukai Y, Imai N, Yamamoto K, et al. The influence of hepatitis C virus eradication on hepatocarcinogenesis in patients with hemophilia: HCC after HCV eradication in hemophilia. Ann Hepatol. Published online September 24, 2021. doi:10.1016/j.aohep.2021.100545