Longer-term Survival of UK People with Bleeding Disorders Infected by Human Immunodeficiency Virus and/or Hepatitis C...

Between 1970 and 1991, when viral inhibition reduced the risk, people with a bleeding disorder in the United Kingdom had their missing clotting factors replaced with plasma products derived from donated plasma at risk of infection. We analyzed longer-term survival of people with bleeding disorders exposed to plasma products.

The National Haemophilia Database documents people with bleeding disorders registered, treated before, and alive on 1 January 1992. We estimated all-cause mortality proportional hazard ratios for exposure groups (Human immunodeficiency virus (HIV)/Hepatitis C virus (HCV) coinfected, HCV-diagnosed, and HCV-status unknown) versus HCV antibody negative, within distinct epochs: 1992-1999; 2000-2009; 2010-2019. We estimated years of life lost by epoch and exposure group versus UK general population lifetables or via parametric survival models compared with people with bleeding disorders negative or unknown for HCV antibodies. Models were adjusted for sex, age band at 1 January 1992, bleeding disorder, and severity.

Of 6282 people with bleeding disorders who met inclusion criteria, 15% were HIV/HCV coinfected, 32% HCV antibody positive, and 28% HCV antibody negative. Compared with HCV-negative, those HIV/HCV coinfected had an all-cause mortality hazard ratio of 4.2 (95% confidence interval: 2.9, 6.0) and HCV+ of 2.2 (1.7, 2.8) in 2010 to 2019. Years of life lost for 2014 to 2019 were 740 (95% confidence interval: 440, 1030) for HCV+ persons and 270 (130, 400) for HIV/HCV coinfected persons, compared with HCV unknown or negative persons.

People with bleeding disorders in the United Kingdom infected before, but alive at, 1 January 1992, were still at increased risk of death 3 decades postimplementation of HCV screening of blood supplies.