Severe Acute Exacerbation of HCV Infection in Cancer Patients Who Undergo Chemotherapy Without Antiviral Prophylaxis

Yuan-Rung Li; Wen-Chi Chen; Wei-Lun Tsai; Jin-Shiung Cheng; Feng-Woei Tsay; Sung-Shuo Kao; Hui-Chun Chen; Ping-I Hsu

Disclosures

J Viral Hepat. 2020;27(9):873-879. 

In This Article

Abstract and Introduction

Abstract

No guidelines have been developed for the management of HCV-infected cancer patients receiving chemotherapy. The current study aimed to investigate the incidence of severe acute exacerbation of HCV infection in cancer patients receiving chemotherapy and to search for risk factors predicting severe acute exacerbation of HCV infection. This retrospective cohort study reviewed the clinical data of the cancer patients receiving chemotherapy in our institute from August 2012 to December 2017. Incidences of severe acute exacerbation of HCV infection in different kinds of cancers were assessed, and risk factors were analysed. Cancer patients with HCV infection (n = 306) had a higher frequency of severe acute liver injury (2.3% vs 0.7%; P = .003) than those without HCV infection (n = 4419). The incidence of severe acute exacerbation in HCV-infected haematological cancer patients was higher than that in those with HCC and non-HCC solid tumours (9.4% vs 1.9% and 1.1%). Rituximab-containing chemotherapy and haematological malignancy were the risk factors related to the acute exacerbation (P < .001 and P = .004, respectively). None of the patients with severe acute HCV flares developed hepatic decompensation or mortality. However, 57.1% of them discontinued chemotherapy due to liver dysfunction. In conclusion, HCV infection increases the risk of acute severe liver injury in cancer patients undergoing chemotherapy. Rituximab-containing chemotherapy and haematological malignancy are the risk factors related to severe acute exacerbation of HCV infection in cancer patients undergoing chemotherapy. Pre-chemotherapy HCV testing is therefore mandatory before rituximab-containing chemotherapy for the treatment of haematological malignancy.

Introduction

Hepatitis C virus (HCV) infection is still a major health problem in the world, affecting millions of people.[1] People infected with HCV have high risk of chronic hepatitis, which may then progress to cirrhosis and hepatoma.[2] Chemotherapy can lead to immunosuppression and reactivate quiescent viral infection. HCV reactivation in patients receiving cancer treatment has been reported in retrospective studies.[3–5] Reactivation of HCV replication with an increase in serum HCV RNA during chemotherapy has been reported in 23% of the cancer patients, including 36% of patients with haematological malignancies and 10% of patients with solid tumours.[6]

Virus reactivation is a serious problem, particularly in HBV-infected cancer patients receiving chemotherapy. To improve pre-chemotherapy HBV and HCV testing, we developed a computerized order entry-based therapeutic control system (e-CONTROL) to notify healthcare providers in our institute for pre-chemotherapy HBV and HCV testing as well as prophylaxis for HBV flares when prescribing chemotherapy agents in 2012.[7] Acute exacerbation of HBV infection can lead to delay and disrupt chemotherapy, or result in hepatic failure and death in severe cases.[8–10] However, a prospective observational study showed no patient with reactivation of HCV infection during chemotherapy experienced liver failure or liver-related death within 36 weeks after initiation of cancer treatment.[6]

Currently, guidelines for pre-emptive antiviral therapy in HBV-infected patients undergoing chemotherapy have been established. Additionally, antiviral agents are now employed to prevent hepatitis B flares in HBV-infected cancer patients who receive chemotherapy.[11–13] However, no guidelines have been developed for the management of HCV-infected cancer patients receiving chemotherapy because data on severe acute exacerbation of HCV infection following chemotherapy are very limited. We therefore aimed to investigate the incidence of severe acute exacerbation of HCV infection in cancer patients receiving chemotherapy and to identify risk factors predicting severe acute exacerbation of HCV infection in those undergoing chemotherapy.

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