Hepatitis C virus reactivation in patients receiving cancer treatment: A prospective observational study

Abstract

Hepatitis C virus (HCV) reactivation in patients receiving cancer treatment has been reported in retrospective studies. We sought to determine prospectively the incidence, predictors, and clinical significance of HCV reactivation during cancer treatment. HCV-infected patients receiving cancer treatment at our institution (11/2012-07/2016) were studied. Reactivation was defined as an increase in HCV-RNA ≥1 log₁₀ IU/mL over baseline and hepatitis flare as alanine aminotransferase (ALT) increase to ≥3 times the upper limit of normal. One hundred patients were studied, 50 with hematologic malignancies and 50 with solid tumors. Reactivation occurred in 23 patients (23%), including 18 patients (36%) with hematologic malignancies and 5 (10%) with solid tumors. In univariate analysis, patients with reactivation were more likely than those without, to have prolonged lymphopenia (median, 95 vs 22 days, P=0.01) and to have received rituximab (44% vs 9%, P<0.0001), bendamustine (22% vs 0%, P<0.001), high-dose steroids (57% vs 21%, P=0.001), or purine analogs (22% vs 5%, P=0.02). Rituximab (odds ratio [OR]=9.52, P=0.001), and high-dose steroids (OR=5.05, P=0.01) retained significance in multivariable analysis. Of the 23 patients with reactivation, 10 (43%) had hepatitis flare. No patient with reactivation experienced liver failure or liver-related death within 36 weeks after initiation of cancer treatment. Fourteen patients with hepatitis flare of whom 6 had reactivation, required discontinuation or dose reduction of cancer treatment. Conclusions HCV reactivation occurred in 23% of HCV-infected patients receiving cancer treatment, and most had an unremarkable clinical course. However, reactivation can affect the cancer treatment plan. Our findings suggest that HCV infection should not contraindicate cancer therapy and infected patients should have access to multiple cancer treatments with close monitoring while receiving regimens associated with HCV reactivation. This article is protected by copyright. All rights reserved.

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