Before the early 1990s, contaminated clotting factor concentrates passed HCV to a disproportionate number of patients. Not through any exposure they chose, but through the treatments that kept them alive. The CDC now documents that nearly 3 in 4 men with hemophilia have a history of prior HCV infection.
And while that history is real and heavy, the treatment landscape has changed completely.
The answer lies in how clotting factor concentrates were manufactured before reliable screening existed.
For people with hemophilia A or B, factor replacement therapy (infused concentrates of Factor VIII or Factor IX) was and remains the cornerstone of treatment. Before the early 1990s, those concentrates were produced by pooling plasma from tens of thousands of individual donors. A single manufactured lot could draw from an enormous number of contributions. That pooling process created a reliable therapy supply. It also created a single point of catastrophic vulnerability.
Before blood-borne viruses were fully understood, before antibody screening tests were available, and before viral inactivation processes became standard, hepatitis C moved through the bleeding disorders community at scale. The reach of that exposure reflects how completely the virus traveled through a community whose treatment depended on products derived from unscreened blood.
In the United States, routine HCV antibody screening of the blood supply began in 1992, and modern manufacturing has since made plasma-derived products extremely safe. But for those who received factor concentrates in the decades before that, the exposure was real, and the consequences have followed many patients for a long time.
HCV is a disease of the liver. For people with bleeding disorders, that intersection carries specific clinical weight.
The liver is where the majority of clotting factors are synthesized. As chronic hepatitis C causes progressive fibrosis and cirrhosis, the liver’s capacity to produce those clotting factors declines. For a patient already managing a bleeding disorder, advancing liver disease from untreated HCV adds a layer of bleeding risk that works directly against the condition they are already treating.
Advanced liver disease from chronic HCV can also cause portal hypertension, meaning elevated pressure in the vessels that drain blood through the liver, which in turn can depress platelet counts and increase the risk of gastrointestinal bleeding. For patients managing hemophilia or von Willebrand disease alongside chronic liver disease, close coordination between a hematologist and a hepatologist or infectious disease specialist is essential, not optional.
HCV also tends to progress more quickly in people who are co-infected with HIV. The bleeding disorders community was disproportionately affected by HIV through the same route of contaminated blood products, making co-infection an important clinical reality for many older patients in this community.
Here is the part of this story that has changed completely. And for anyone who went through earlier treatment attempts that didn’t work or were difficult to tolerate, this is worth reading carefully.
For most of the 2000s, the standard treatment for HCV was a combination of pegylated interferon and ribavirin. The regimen lasted up to 11 months, produced severe side effects including flu-like symptoms, anemia, and depression, and achieved a cure in roughly half of patients. For people with bleeding disorders managing complex co-morbidities, the treatment was particularly hard, and the outcomes were uncertain.
That era is over.
Direct-acting antivirals (DAAs) have transformed hepatitis C treatment. These are oral medications, taken as pills over an 8 to 12-week course, that directly target the hepatitis C virus itself. According to both the CDC and WHO, DAAs cure more than 95% of people with hepatitis C. They are well-tolerated, have a favorable side effect profile, and have proven as effective for people with hemophilia and other bleeding disorders as they are for the general population.
A 2026 analysis of national prescribing trends published in JAMA estimated that, despite this highly effective oral treatment being available since 2013, only about 1 in 3 people with hepatitis C in the United States have received antiviral treatment. The cure exists. The treatment gap is the problem.
Hepatitis C is notoriously quiet in its early stages. Symptoms often don’t appear until significant liver damage has already accumulated, sometimes decades after initial exposure. Many people who were infected before 1992 may not know they have HCV, or may have been diagnosed years ago and lost track of treatment follow-up.
For some in the bleeding disorders community, earlier experiences with interferon-based treatment that failed or caused serious side effects may have left understandable reluctance to try again. What they may not know is that today’s treatment looks nothing like that experience. Eight to twelve weeks of pills. A cure rate above 95%. No interferon. No hospital admissions for treatment-related complications.
The CDC recommends HCV testing for all adults at least once, and specifically recommends testing for anyone who received clotting factor concentrates or blood transfusions before 1992. If you or a patient you care for falls into that category and has never been tested, or was diagnosed but never completed treatment, this World Hepatitis Day is a meaningful moment to act on that.
It’s worth being clear about what LUX Infusion does in this picture. HCV treatment itself (the direct-acting antivirals that cure the infection) is managed by hepatologists and infectious disease specialists through a short course of oral medication. That’s not what we do.
What we do is provide the ongoing infusion care that people with bleeding disorders depend on for the long-term management of their condition. Factor replacement therapy for hemophilia A and B, and other infused therapies for the bleeding disorders community, require a care partner who understands the clinical complexity these patients live with. For many of those patients, that history includes HCV.
At LUX Infusion, we are clinician-led and built for exactly this kind of long-term, coordinated care. We work closely with your referring provider, sharing data and updates throughout treatment so that the full team managing your health stays connected. We offer both home infusion and ambulatory infusion center care nationwide, with flexible scheduling and a dedicated patient support team.
To learn more about how LUX Infusion serves the bleeding disorders community, visit LUX Infusion. Explore care options by condition or find a LUX Infusion location near you.
If you or a patient you care for is managing a bleeding disorder and looking for an infusion care partner who understands the full clinical picture, we are here. Referring providers can submit a referral on our website. A welcome call goes out within four hours.
Your history matters. Your care should reflect that.
Is hepatitis C the same as hepatitis A or hepatitis B?
No. Hepatitis A, B, C, D, and E are caused by different viruses and follow different transmission routes, disease courses, and treatment approaches. Hepatitis A is typically an acute, self-resolving illness. Hepatitis B can become chronic but has an effective vaccine. Hepatitis C has no vaccine, can become a long-term chronic infection, and, most importantly, is now curable in more than 95% of cases with oral direct-acting antivirals. It is hepatitis C specifically that has had the most significant impact on the bleeding disorders community due to contaminated clotting factor products.
Can someone with a bleeding disorder safely take direct-acting antivirals for HCV?
Yes. Studies have demonstrated that DAA-based treatment is effective and well-tolerated in people with hemophilia and other bleeding disorders, with cure rates comparable to the general HCV-positive population. Treatment should be coordinated by a hepatologist or infectious disease specialist familiar with the patient’s full medical picture, including their hematologist.
If I was treated for hepatitis C years ago but it didn’t work, are there better options now?
Very likely, yes. Earlier interferon-based regimens had significant limitations and left many patients without a sustained cure. Direct-acting antivirals represent a fundamentally different class of treatment and have achieved high cure rates even in patients who did not respond to prior therapy. Anyone who attempted treatment before the DAA era and did not achieve a sustained virologic response should ask their physician whether retreatment is appropriate.
Does having hepatitis C affect how factor replacement therapy works?
Not directly, but chronic liver disease from untreated HCV can reduce the liver’s own production of clotting factors over time, which may complicate bleeding disorder management. This is one reason why monitoring liver health is important for patients in the bleeding disorders community who have HCV, and why coordinated care between hematology and hepatology matters.
Who in the bleeding disorders community should get tested for hepatitis C?
The CDC recommends HCV testing for all adults at least once. For the bleeding disorders community specifically, anyone who received clotting factor concentrates or blood transfusions before 1992 should be tested if they have not been already. Testing is a simple blood test. Knowing your status is the first step toward accessing a treatment that can now cure HCV in the vast majority of people who receive it.
LUX Infusion is elevating infusions into an experience. As a U.S.-based, clinician-led infusion services company, we provide both home infusion and ambulatory infusion center services, bringing clarity, compassion, and expertise to every patient relationship. With faster therapy starts, dedicated patient support, and continuous data sharing with providers, LUX Infusion ensures patients feel supported, and providers and partners can trust in better adherence and outcomes. For more information, visit luxinfusion.com.
Disclaimer
This content is for informational purposes only and is not intended to serve as a substitute for the consultation, diagnosis, and/or medical treatment of a qualified physician or healthcare provider, or as legal advice. Please consult a physician or other healthcare professional for your specific health care and/or medical needs or concerns and never disregard professional medical advice or delay in seeking it because of something you have read here or on our website.
References
1. Centers for Disease Control and Prevention. Data and Statistics on Hemophilia. Accessed June 2026. https://www.cdc.gov/hemophilia/data-research/index.html
2. Centers for Disease Control and Prevention. Clinical Overview of Hepatitis C. Updated August 2025. https://www.cdc.gov/hepatitis-c/hcp/clinical-overview/index.html
3. World Health Organization. Hepatitis C Fact Sheet. Updated July 2025. https://www.who.int/news-room/fact-sheets/detail/hepatitis-c
4. Sharafi H, Behnava B, et al. Treatment of hepatitis C virus infection with direct-acting antiviral agent-based regimens in patients with hereditary bleeding disorders. Virol J. 2021;18:199. https://pmc.ncbi.nlm.nih.gov/articles/PMC8496886/
5. National Prescribing Trends of Direct-Acting Antivirals for Hepatitis C, 2013–2025. JAMA. Published 2026. https://jamanetwork.com/journals/jama/fullarticle/2846850 [Note: Confirm full citation before publish. CIDRAP summary: https://www.cidrap.umn.edu/hepatitis/hepatitis-c-curable-yet-only-1-3-patients-receive-antiviral-drugs-study-estimates]
6. Centers for Disease Control and Prevention. HCV Clearance Cascade — United States, 2013–2022. MMWR. 2023;72(26). https://www.cdc.gov/mmwr/volumes/72/wr/mm7226a3.htm
7. Hemophilia Federation of America. History of Bleeding Disorders. https://www.hemophiliafed.org/history-of-bleeding-disorders/
8. HemAware. Coping with Hepatitis C When You Have a Bleeding Disorder. Updated September 2023. https://hemaware.org/bleeding-disorders-z/hepatitis-c-self-care-and-testing
9. National Day Calendar. World Hepatitis Day, July 28. https://nationaldaycalendar.com/celebrations/world-hepatitis-day-july-28
