HIV infection and haemophilia

Article Abstract:

Hemophilia is a hereditary blood disorder characterized by a prolonged coagulation time. The failure of the blood to clot results in abnormal bleeding. Patients with hemophilia are treated with transfusions of blood products, factor VIII and IX, which help to stop the bleeding. However, contamination of the blood and blood products with human immunodeficiency virus (HIV) has resulted in the infection of some hemophiliac patients with HIV. As of March 1990, there were 237,110 cases of AIDS reported to the World Health Organization. Among 1,201 people with hemophilia and HIV infection in the United Kingdom, 194 developed AIDS by May 1990, including 130 who died. Studies show that, with the exception of newborns, younger patients who are infected with HIV generally have a slow disease progression period. HIV infection does not appear to influence the growth of hemophiliac children, although children infected at birth show a failure to thrive. The care of HIV-infected hemophiliacs should address six primary areas of need for patients and their families, including accurate diagnosis, safe and effective treatment, 24-hour care, regular follow-up, expert counselling, and clear communication from medical professionals. HIV infection is complicated by various infections and disorders that can be prevented or alleviated with specific drugs. For example, inhaled pentamidine is helpful in preventing Pneumocystis carinii pneumonia. The complications of HIV infection and the side effects of the drugs recommended for treatment are discussed. Although the schooling of HIV-infected children should not be affected, the free exchange of information is restricted due to the infected child's right to privacy. HIV-infected adolescents may need more extensive counselling, as they are experiencing major changes in their life, such as potential sexual relationships. The current treatment of hemophilia and compensation for HIV-infected hemophiliac children are also discussed. (Consumer Summary produced by Reliance Medical Information, Inc.)

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Safety trial of heated factor VIII concentrate (8Y)

Article Abstract:

The care and treatment of hemophilia has improved drastically with the use of factor VIII concentrates (clotting factors) prepared from donated blood. However, non-A, non-B hepatitis and human immunodeficiency viruses (HIV) can be transmitted to the patient via contaminated products. Factor VIII concentrate (type 8Y) was heated at 80 degrees C for 72 hours and tested in 17 previously untreated hemophiliac boys (ages 2 weeks to 15 years; average age approximately 14 months), to evaluate the risk and incidence of viral transmission by 8Y. The effect of 8Y on liver function was also measured. Blood samples were collected before the first dose of 8Y was received and at monthly intervals thereafter throughout the treatment, which lasted between 4 and 36 months. HIV antibodies were not detected in any boy's blood. Also, liver function, as determined by enzyme activity, did not change, which suggests that 8Y does not transmit non-A, non-B hepatitis viruses. Therefore, 8Y appears to be a safe, effective and useful product to treat hemophilia without the risk of transmitting specific hepatitis and HIV. However, conducting safety trials in young patients has inherent problems, such as pain and trauma of regular blood collection by puncturing a vein because personnel may be unwilling to collect capillary blood until its safety has been determined, and the lack of commitment coming from the parent because the individual benefit to the child is not immediate. This study should ease the anxiety of the hospital staff in that the safety of the blood product has been demonstrated. To facilitate compliance of parents, they can be advised of the importance of providing information about the safety of products for the effective treatment of their sons, because liver disease is a serious problem in hemophiliacs. (Consumer Summary produced by Reliance Medical Information, Inc.)

Case studies, HIV (Viruses), HIV, Contamination, Blood coagulation factor VIII, Factor VIII (Blood coagulation), Hepatitis C virus

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Growth in haemophilic boys after HIV infection

Article Abstract:

Infection of the newborn with the human immunodeficiency virus (HIV) during birth is associated with failure to thrive, a marked inability to achieve a normal rate of growth. The effects on growth and development of HIV infection acquired at a later stage of childhood are not known. Hemophilia A is an inherited blood disease, characterized by a greatly prolonged blood-clotting time, which results from a deficiency in the blood coagulation factor VIII. Patients with this blood disease require blood transfusions of factor VII concentrate, and are at increased risk of HIV infection transmitted by contaminated blood products. The growth of 27 boys with hemophilia A and HIV infection acquired through transfusion of factor VIII concentrate was assessed. HIV seroconversion is the development of antibodies, or immune proteins, in the blood that specifically act against HIV; in these boys, HIV seropositivity was recorded between 1981 and 1986. The effects of HIV seroconversion on growth patterns were studied by analyzing height and weight over a period of 9.2 years. The average time required for HIV seroconversion was 4.5 years. The findings showed that there was no change in the growth pattern as determined by height and weight after HIV seroconversion. These boys will be continually monitored to determine whether progression of HIV disease affects growth patterns. (Consumer Summary produced by Reliance Medical Information, Inc.)

HIV patients, Growth

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