Ageing with Haemophilia: Comorbidities in Focus

Area of Science:

• Gerontology and Hematology
• Public Health and Epidemiology

Background:

• Life expectancy for people with haemophilia (PWH) has significantly increased, leading to an aging population.
• This demographic shift presents challenges including age-related diseases and long-term effects from historical treatments, such as chronic hepatitis C virus (HCV) and HIV infections.
• Joint damage, pain, and functional limitations persist due to past insufficient prophylaxis, while cardiovascular, metabolic, and psychological comorbidities are increasingly prevalent.

Purpose of the Study:

• To describe the diverse comorbidity profile of older people with haemophilia (PWH).
• To highlight the interplay between haemophilia-specific sequelae and general aging population health issues.
• To inform future care strategies for this growing population.

Main Methods:

• Review of existing literature and clinical data on aging PWH.
• Analysis of comorbidity patterns, including haemophilia-specific factors (viral exposures, arthropathy) and general age-related conditions.
• Assessment of the impact of historical and current treatment paradigms on long-term health outcomes.

Main Results:

• Older PWH exhibit a complex health profile, with chronic arthropathy being a major driver of disability, increasing risks for reduced mobility, osteoporosis, and fractures.
• Cardiovascular diseases, including hypertension and atherosclerosis, are increasingly significant, complicating standard cardiac care with hemostatic considerations.
• Metabolic conditions (obesity, diabetes) and cancers occur at rates similar to the general population, often clustering with cardiovascular risk factors. Psychological symptoms like depression and anxiety are common, linked to chronic pain and social isolation.

Conclusions:

• The health of aging people with haemophilia (PWH) is shaped by a combination of haemophilia-related issues (joint damage, viral infections) and common comorbidities of aging.
• Chronic arthropathy, cardiovascular disease, metabolic disorders, and psychological symptoms are key determinants of morbidity in this population.
• Future cohorts may experience less joint morbidity due to improved prophylaxis, but the long-term vascular effects of newer therapies require continued monitoring, emphasizing the need for sustained multidisciplinary care.