Hepatitis C seropositivity in HIV-negative children with severe haemophilia

With the advent of new viral inactivation and purification methods for factor concentrates in the 1980s, transmission of both HIV-1 and hepatitis viruses has been significantly decreased. However, on routine annual testing of the paediatric population at the New England Hemophilia Center (NEHC), several children were noted to be hepatitis C (HCV) seropositive. Thus, a retrospective review of children with severe haemophilia was undertaken. Twenty-six children (median age: 7.5 years) under the age of 12 were identified. All were HIV-1 seronegative and had received hepatitis B immunization. Of these, 22 had received factor concentrate. Four children had no documented HCV serostatus, and seven were HCV seropositive using a second-generation ELISA. Transfusion products were reviewed and stored serum samples were evaluated using a second-generation ELISA to identify the approximate date of seroconversion with positive tests confirmed by RIBA analysis. Three children became seropositive before 1989 using factor concentrates with early viral attenuation procedures. Two children who seroconverted after 1991 received only monoclonal affinity purified factor concentrate that was either pasteurized or solvent/detergent treated. There was no evidence of horizontal or nosocomial viral transmission. We are unable to prove causality with the factor concentrates used by these children. Continued surveillance with sensitive measures for detection of HCV in persons with haemophilia using plasma-derived factor concentrate is necessary.