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


During the study period, a total of 5735 patients received chemotherapy at the Kaohsiung Veterans General Hospital, of whom 5601 patients were tested for HBsAg and anti-HCV, giving a screen rate of 97.7%. Among the 5601 patients, 654 had a haematological malignancy, and 4,947 had solid tumours (499 had HCC, and 4,448 had non-HCC tumours). Among the patients with complete tests, the prevalence of HBV infection, HCV infection and co-infection was 15.1%, 5.4% and 0.6%, respectively. HCC patients had a higher prevalence rate of HBV (46.3% vs 11.9%; P < .001) and HCV infection (21.0% vs 3.8%; P < .001) than those without HCC. Table 1 lists the prevalence rates of HCV and HBV infection in the patients receiving chemotherapy.

Among the 5601 patients, 306 were anti-HCV (+) and HBsAg (-), and 4419 had negative results for both tests. Table 2 shows the demographic data of the patients included in the study. Among them, seven of 306 anti-HCV (+) patients (2.3%) experienced severe acute liver injury. Thirty-two of 4419 patients (0.7%) negative HBsAg but who developed anti-HCV had severe acute liver injury. Patients with HCV infection had a higher incidence of severe acute liver injury than those without HCV infection (2.29% vs 0.72%; P = .003). Table 3 shows the frequencies of severe liver injury in patients with different kinds of cancers. The incidence of severe liver injury in HCV-infected patients with haematological malignancy, HCC and non-HCC solid tumours was 9.38% (3/32), 1.90% (2/105) and 1.18% (2/169), respectively. Among the patients without HCV infection, the incidence of severe liver injury in those with haematological malignancy, HCC and non-HCC solid tumours was 4.10% (22/537), 0.66% (1/151) and 0.24% (9/3731), respectively. Overall, HCV-infected cancer patients had a higher incidence of severe hepatitis during chemotherapy than those without HCV infection (2.3% vs 0.7%, P = .003).

In this study, the incidence of severe acute exacerbation rate in HCV-infected haematological cancer patients was higher than that in those with HCC patients and non-HCC solid tumours (9.4% vs 1.9% and 1.1%; P = .048 and .006, respectively). Table 4 displays the chemotherapy agents used for cancer treatment in the 7 patients who developed HCV-related severe liver injury, and Table 5 shows the clinical outcomes of them. Severe liver injury in HCV-infected cancer patients improved after supportive care. However, 4 patients had persistent hepatitis activity 4 weeks after flare-up of HCV infection. Among them, two received rituximab for lymphoma; one received bevacizumab and platinum-based therapy for peritoneal cancer, and one received HAIC for HCC. The rates of liver decompensation related to severe acute hepatitis of HCV infection were all 0% in these HCV-infected patients with severe liver injury during chemotherapy. No patient died because of severe liver injury related to HCV infection. However, acute flare of HCV infection could affect the cancer treatment plan. Four of the seven patients (57.1%) developing severe acute flare of HCV infection discontinued chemotherapy due to liver dysfunction.

Table 6 shows the data of univariate analysis for the clinical factors related to the development of severe acute liver injury in HCV-infected cancer patients. Haematological malignancy and rituximab-containing regimens were two identified risk factors related to severe acute exacerbation of HCV infection (P = .004 and <.001, respectively). Because the number of anti-HCV (+) patients receiving rituximab-containing chemotherapy was too small for adequate regression analysis, multivariate analysis was not conducted to search for independent risk factors predicting severe acute exacerbation of chronic HCV infection.