Other DAA combinations under evaluation for G1-HCV include SOF/simeprevir, SOF/daclatasvir, SOF/GS9669, ABT450/r/ABT267/ABT-333+/− ribavirin, daclatasvir/asunaprevir and faldaprevir/BI207127+/−
RBV. These regimens have not yet been evaluated in patients with bleeding disorders, but would be expected to be effective. G3-HCV is emerging as more difficult to treat in the interferon-free era, with a longer duration of treatment with SOF/RBV appearing beneficial . Studies of SOF combined with NS5A inhibitors for treatment of G3-HCV are ongoing. All-oral, interferon-free treatment of HCV is now a reality, although the optimal regimens are still being evaluated. Elderly patients with haemophilia (PWH) have different problems to patients of younger generations. With ageing, patients GSK-3 inhibition suffer from haemophilia-related co-morbidities like chronic arthritis and viral infection. Age-related co-morbidities, internal and cardiovascular disease (CVD), urological problems and cancer are becoming more common. It is important to look for ways
to prevent or reduce co-morbidity and improve the quality of life of ageing PWH. Haemophilia care givers should play a role in this and during annual check-ups not only pay attention to haematological and orthopaedic aspects of haemophilia, but also to age-related co-morbidities. Co-morbidities in PWH may lead to complex treatment. Lack of coordination between various healthcare workers BYL719 nmr may result in slow and ponderous healthcare delivery, uncontrolled polypharmacy, and further loss of wellbeing and quality of life. Therefore,
haemophilia centres should play an important part in coordinating care for these patients. Except for hepatocellular carcinoma, due to chronic hepatitis C virus (HCV) infection, the risk of developing malignancy is not increased in PWH not infected with HIV. In general treatment for PWH is the same as for other patients. When chemotherapy is required, blood counts may drop and it is recommended to perform blood counts regularly. In case of thrombocytopenia, intensive prophylaxis with clotting factor may be indicated . Haemophilia patients have a higher mean blood pressure and use more MCE antihypertensive medication than the general population . The cause of this increased prevalence is not completely understood. A recent Dutch study showed that the prevalence of hypertension was significantly higher in PWH than in the general population in the age categories 40–49 years [41% (95% CI, 34–48) vs. 29% (95% CI, 26–32)] and 60 years or older [82% (95% CI, 75–88) vs. 71% (95% CI, 68–74)]. In this study, hypertension was not significantly associated with severity of haemophilia, renal function, a history of renal bleeding or infection with HCV or HIV, but it was associated with being overweight/obesity and age . As hypertension is a risk factor for CVD and intracranial bleeding, blood pressure in PWH should be regularly checked and hypertension adequately treated.