Higher Prevalence of Hepatitis B and C Infections among Indian Patients with Von Willebrand Disease

Background: The use of recombinant coagulation factors has reduced the incidence of hepatitis B and C infections in hemophilia patients. As recombinant von Willebrand factor is not easily available, patients with von Willebrand disease (VWD) may be at higher risk for acquiring hepatitis B and C infections. The prevalence of hepatitis B and C infections in the Indian population is ~0.95% and ~0.3%, respectively. Aims: This single tertiary center study aimed to assess the prevalence of hepatitis B and C infections and the profile of liver disease caused by these viruses among patients with VWD. Methodology: We retrospectively enrolled VWD patients treated in our center from January 2012 to December 2022 and analyzed the prevalence of hepatitis B and C infection and stage of liver disease. Results: Among 189 patients with VWD during the study period, 5 of 61 (8.1%) VWD patients screened were hepatitis B surface antigen positive (age: 34 [24–42] years; median (range); plasma VWF antigen: 10.1, [0–40] IU/dL). One patient had cholangiohepatoma at presentation, whereas none had chronic liver disease. Four of five patients received multiple bloodproduct transfusions before coming to our institution, with 10 (7–18) years interval between 1 st transfusion and to detection of hepatitis B infection. Four of the 47 VWD patients (8.5%) screened were positive for hepatitis C virus antibody (48 [43–59] years, plasma VWF antigen: 20 [0–21.5] IU/dL). One patient had chronic liver disease. All four patients received multiple blood product transfusions before coming to our institution, with 15.5 (2–39) years interval between 1 st transfusion and to the detection of hepatitis C infection. Conclusions: The prevalence of hepatitis B infection (8.1%) and hepatitis C infection (8.5%) was 8-fold and 28-fold higher, respectively, in VWD patients than the general population in India. VWD patients remain at high risk for acquiring transfusion-transmitted viral infections and appropriate interventions are needed to address this.