"Safety and Efficacy of Liver Biopsy In HIV Seropositive Hemophiliacs Using a Transjugular Venous Approach."
R. Gupta, E. Druv and C.M. Kessler George Washington University, Washington, D.C.

According to an abstract submitted by the authors to the 46th annual meeting of the National Hemophilia Foundation, held October 27-30, 1994, in Dallas, Texas, "Chronic liver disease has affected a majority of hemophiliacs exposed to factor Vill and factor IX concentrates before effective viral attenuation techniques for lipid encapsulated plasma-born viruses were introduced into the manufacturing process. At least 50% have evidence of prior exposure to hepatitis B and 70-90% have antibodies to hepatitis C. Progressive hepatitis and liver failure have become increasingly important causes of morbidity, especially in hemophilia patients who are also seropositive for HIV. Their previously quiescent liver dysfunction also appears to be activated and exacerbated by anti-HIV medications and perhaps by defective immunity and opportunistic infections. Furthermore, their incidence of hepatocellular carcinoma is increased. The encouraging reports of recombinant alpha interferon to reverse the histological, laboratory, and clinical deterioration of chronic active hepatitis justifies obtaining liver biopsies to assess the severity of liver damage; however, traditionally performed percutaneous procedures carry significant risks of bleeding and expense for clotting factor concentrate coverage. Therefore, we employed a transjugular venous approach for liver biopsies in 4 HCV, HBSAb, and HIV-seropositive adults with severe hemophilia A (N=3) or B (N=1) and persistent liver function abnormalities. Inhibitors to coagulation factors were excluded and factor VIII or IX activities were maintained between 80- 100% with appropriate concentrate doses. A 'catheter was introduced into the right jugular vein and threaded into the right hepatic vein through which serial passes were made into the liver parenchyma to obtain tissue. Adequate specimens were acquired from each patient and no hemorrhagic complication were observed intra or 72 hour post procedure, as confirmed clinically and with serial hematocrits. Three patients had morphologic evidence of chronic active hepatitis and were started on alpha-interferon. The fourth individual had non-specific histological abnormalities attributed to Zidovudine administration. We conclude that liver biopsy using a transjugular approach appears to be safe and effective in individuals with severe hemophilia or other congenital or acquired coagulopathies. The risks of adverse intraperitoneal hemorrhage are minimized as blood loss re-enters the hepatic venous system. Furthermore, the small incision and intraparenchymal procedure should reduce the need for more sustained prophylactic clotting factor coverage. Although potential bleeding complications may rarely occur with this technique, the risk/benefit and cost/benefit ratios are increased over the traditional percutaneous route and should facilitate the evaluation and determination of therapeutic options of liver dysfunction in hemophilia patients."

AIDS Weekly, 12-26-0094, pp 24.

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