Hepatitis screening “may be warranted” following cancer diagnosis
medwireNews: The prevalence of hepatitis B virus (HBV) and hepatitis C virus (HBV) infection in patients with newly diagnosed cancer is similar to that of the US population, but a “substantial proportion” of patients are unaware of their infection, research shows.
Therefore, “[s]creening patients with newly diagnosed cancer to identify hepatitis B virus and hepatitis C virus infection before starting treatment may be warranted to prevent viral reactivation and adverse clinical outcomes,” Scott Ramsey (Fred Hutchinson Cancer Research Centre, Seattle, Washington, USA) and colleagues remark.
On the other hand, the team believes that “universal screening for HIV infection may not be warranted,” because the majority of patients with HIV are aware of their infection at the time of cancer diagnosis.
The prospective cohort study included 3051 patients (median age 60.6 years, 60.4% women) from 14 geographically diverse US States who had been diagnosed with cancer within 120 days of study entry.
Among the 3050 patients screened for HBV, 6.5% had a previous HBV infection and 0.6% had a chronic HBV infection. The prevalence of HCV infection was 2.4% among the 2990 patients screened, while HIV was detected in 1.1% of 3045 study participants.
The researchers found that a high proportion of the HBV and HCV infections were first detected during the study, at 87.3% for previous HBV, 42.1% for chronic HBV, and 31.0% for HCV. By contrast, just 5.9% HIV infections were previously undiagnosed.
Ramsey and co-investigators comment that “the overall prevalence of HBV and HCV infection in patients with cancer is similar to that of the general population” but their findings show that “there is a large reservoir of patients with cancer and undiagnosed hepatitis virus infections.”
Furthermore, 27.4% and 21.1% of participants with previous and chronic HBV, respectively, 32.4% of those with HCV, and 20.6% of patients with HIV had no identifiable risk factors when they completed a survey designed by the researchers to determine viral risk.
The high proportion of patients with no known risk factors for infection suggests that “current risk-based models for screening may be insufficient,” Ramsey et al remark.
“Thus, we believe our results warrant consideration of universal testing of patients with newly diagnosed cancer for HBV and HCV infection, particularly if such an approach is shown to be cost-effective,” the authors write in JAMA Oncology.
The team also notes that only 8.0% of patients with infection had their cancer treatment changed as a result of their virus-positive status, and just 6.3% changed cancer treatment and also began treatment with an antiviral or antiretroviral drug.
In addition, infection rates were highest among patients with liver, gastrointestinal tract other than liver or colorectal, head and neck, lung, and prostate cancers, but the researchers say that “within-cancer frequencies differed substantially by type of viral infection.”
By Laura Cowen
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