In contrast, deaths from ‘other’ diseases (mostly CV) increased significantly Adriamycin ic50 from the period
1982–1995 to 1996–2010 (P < 0.001) in German haemophiliacs. As might be expected, we found that an analysis of deaths by age showed that haemophiliac patients with HIV died at a younger age than patients who died from other causes such as liver disease, cancer and so forth. Finally, Table 5 provides a comparison of deaths in our haemophiliac population in the 5-year period 1978–1983, when the survey was started, with the later period 2003–2008. Haemorrhage was the most common cause of death in the early period (mostly prior to the HIV epidemic) while, more recently, deaths caused by liver disease, cancer, CV diseases and HIV have all increased. Since 1978 the German haemophiliac population has been surveyed on an annual basis to better understand changes in epidemiology, disease status (including morbidity and mortality). This information has been fed into a database which can be interrogated to identify trends, not only from factors such as new treatment regimens and better care, but also from the impact of unexpected events such as the AIDS epidemic. Comparison of data from the 1970s/1980s with that from the 2000s shows a marked shift in causes of death
in the German haemophiliac population with a move away from haemorrhage-related deaths to deaths from other diseases such as liver failure and malignancy. This is indicative of changes that might be expected as the overall age of the population X-396 clinical trial increases and is something that we will continue to monitor. The authors received an honorarium from Grifols S.A. for their participation in the symposium and production of the article. The authors thank Content Ed Net for providing valuable editorial assistance in the preparation of the article; funding for this assistance was provided by Grifols S.A. “
“Summary. Despite continuous improvement in safety and purity cAMP of blood products for individuals with haemophilia, transmissible agents continue to affect individuals with haemophilia. This chapter addresses three viral pathogens
with significant clinical impact: HIV, hepatitis C and parvovirus B19. Hepatitis C is the leading cause of chronic hepatitis and the major co-morbid complication of haemophilia treatment. Clinically, asymptomatic intermittent alanine aminotransferase elevation is typical, with biopsy evidence of advanced fibrosis currently in 25%. Current treatment is effective in up to 70%, and many new agents are in development. For those progressing to end-stage liver disease, liver transplantation outcomes are similar to those in non-haemophilia subjects, although pretransplant mortality is higher. HIV infection, the second leading co-morbid condition in haemophilia, is managed as a chronic infection with highly active antiretroviral therapy (HAART).