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


J Viral Hepat. 2020;27(9):873-879. 

In This Article

Materials and Methods

Patient Identification

A computerized order entry-based therapeutic control system has been adopted in our institute to ensure pre-chemotherapy screening of HBV and HCV infections by testing for HBsAg and anti-HCV antibody since August 2012.[7] This retrospective cohort study reviewed the pre-chemotherapy screening data of newly diagnosed cancer patients registered in our hospital from August 2012 to 31 December 2017 and included inpatients who had undergone their first systemic oral or intravenous chemotherapy. Exclusion criteria were (a) cancer treatment with hormone therapy alone and (b) local chemotherapy with intracavity instillation of cytotoxic agents. This investigation was approved by our institutional review board, which waived the informed consent requirement.


Patient charts were reviewed, and data were recorded on age, gender, type of malignancy, tumour stage, chemotherapy agents, department administering chemotherapy, HBsAg and anti-HCV testing () within 2 years prior to chemotherapy, and anti-HBV medications were administered during chemotherapy. Cancers were classified as haematological malignancies, hepatocellular carcinoma (HCC) and solid tumours other than HCC. The incidence of severe liver injury in patients with HCC, non-HCC solid tumours and haematological malignancies was assessed and compared. Severe acute liver injury was defined as serum alanine aminotransferase (ALT) increases beyond 10 times the upper limit of normal (ALT level ≧ 400 IU/L) during chemotherapy or 6 months following chemotherapy. Severe acute exacerbation of HCV infection was defined as (a) serum ALT increases beyond 10 times the upper limit of normal during chemotherapy or within 6 months following chemotherapy, (b) the presence of anti-HCV in serum and (c) exclusion of liver injury due to superinfection or co-infection with hepatitis A, B and D viruses, alcoholic liver disease, autoimmune hepatitis, drug hepatitis or major systemic events (eg shock, hypoxia, haemolytic anaemia).

Liver decompensation related to severe acute exacerbation of HCV was defined as severe acute exacerbation of HCV infection with the development of serum total bilirubin level over 2 mg/dL, occurrence of hepatic encephalopathy or a finding of abnormal coagulopathy (an international normalized ratio of prothrombin to time greater than 1.5). Fatal acute exacerbation of HCV infection was defined as (a) fatal consequences because of complications of hepatic failure following severe acute exacerbation of HCV infection and (b) exclusion of mortality resulting from other major systemic diseases (eg acute myocardial infarct, cerebral vascular accident, severe infection). The adjudication committee of the study confirmed the causes of death.

Statistical Analysis

Primary outcomes were (a) the incidence of severe acute liver injury in cancer patients receiving chemotherapy and (b) the incidence of severe acute exacerbation of HCV infection in cancer patients who had HCV infection and underwent chemotherapy. Secondary outcomes were (a1) the frequency of liver decompensation in cancer patients who received chemotherapy and developed severe acute exacerbation of HCV infection and (b) the frequency of discontinuing chemotherapy due to severe acute exacerbation of HCV infection. Only the events confirmed by the hepatic injury review panel were included in the analysis.

The outcomes were analysed using the chi-squared test with Yates' correction or Fisher's exact test for categorical data. The Student t test was utilized for comparison of continuous variables. To determine the independent factors affecting the acute exacerbation of HCV infection in patients receiving chemotherapy, patient characteristics and type of chemotherapy were analysed by univariate analysis. Those variables found to be significant by univariate analysis were subsequently assessed by a forward logistic regression method to identify independent factors predicting severe acute exacerbation of HCV infection. Statistical calculations were performed using the SPSS software (version 10.1; Chicago, IL), with P < .05 considered statistically significant. All P values were two-sided.