Longer-term survival of UK people with bleeding disorders infected by Human Immunodeficiency Virus and/or Hepatitis C Virus through contaminated blood transfusions

Background<br/>Between 1970-1991 when viral inhibition reduced the risk, people with a bleeding disorder in the UK 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.<br/><br/>Methods<br/>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 (HR) for exposure groups (Human Immunodeficiency Virus (HIV)/ Hepatitis C Virus (HCV) co-infected, HCV-diagnosed, and HCV-status unknown) vs HCV antibody negative, within distinct epochs: 1992-1999; 2000-2009; 2010-2019. We estimated years of life lost (YLL) by epoch and exposure group versus UK general population lifetables or via parametric survival models compared to 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.<br/><br/>Results<br/>Of 6,282 people with bleeding disorders who met inclusion criteria, 15% were HIV/HCV co-infected, 32% HCV antibody positive, and 28% HCV antibody negative. Compared with HCV-negative, those HIV/HCV co-infected had an all-cause mortality HR of 4.2 (95% CI 2.9,6.0) and HCV+ of 2.2(1.7,2.8) in 2010-19. YLL for 2014-19 were 740(95% CI 440,1030) for HCV+ persons and 270(130,400) for HIV/HCV coinfected persons, compared with HCV unknown or negative persons.<br/> <br/>Conclusion<br/>People with bleeding disorders in the UK infected prior to, but alive at, 1 January 1992, were still at increased risk of death 3 decades post implementation of HCV screening of blood supplies.<br/>