Study Finds Large Number of Patients With Cancer Who Have Undiagnosed Hepatitis, HIV

A study published in JAMA Oncology found that a substantial proportion of patients with newly diagnosed cancer had concurrent hepatitis B virus (HBV) or hepatitis C virus (HCV) infection that they were unaware of at the time of cancer diagnosis.

The multicenter, prospective, cohort Viral Screening in Newly Diagnosed Cancer Patients study included 3,051 eligible patients (median age = 60.6 years; range = 18.2-93.7 years) with newly diagnosed cancer who were identified within 120 days of cancer diagnosis from nine academic and nine community oncology institutions affiliated with SWOG Cancer Research Network. Patients were enrolled between August 29, 2013, and February 15, 2017. Most patients (n=1,842; 60.4%) were female, 553 (18.1%) were black, and 558 (18.3%) were Hispanic.

Cohort study of 3K pts w/ new cancer dx. Among pts w/ + viral tests, 42% w/ chronic hep B, 31% w/ hep C, & 6% w/ HIV were newly dx’d on study tests. (Me: expect even more objections to excl criteria saying “known” Hep B/C or HIV. If it matters, test!) https://t.co/Mj2l6i6jXw

— Tatiana Prowell, MD (@tmprowell) January 19, 2019

The observed infection rate was 6.5% for a previous HBV infection (n=197; 95% CI, 5.6-7.4), 0.6% for chronic HBV (n=19; 95% CI, 0.4-1.0), 2.4% for HCV (n=71; 95% CI, 1.9-3.0), and 1.1% for HIV (n=34; 95% CI, 0.8-1.6). At enrollment, many patients did not know they were infected, including 87.3% of those with HBV, 42.1% of those with chronic HBV, 31% of those with HCV infection, and 5.9% of those with HIV.

Among the patients with viral infections, the following were newly diagnosed throughout the study: eight (42.1%) with chronic HBV (95% CI, 20.3-66.5), 22 (31%) with HCV (95% CI, 20.5-43.1), and two (5.9%) with HIV (95% CI, 0.7-19.7). Four patients (21.1%) with HBV (95% CI, 6.1-45.6), 23 (32.4%) with HCV (95% CI, 21.8-44.5), and seven (20.6%) with HIV (95% CI, 8.7-37.9) had no identifiable risk factors.

Congrats to @fredhutch #hicor #swog investigators @ScottDRamsey @junger47 and others on this important publication. Clinically, I’ve been on both the pre-chemo prophy and reactivated hep B/C post-chemo sides. The latter can be devastating. https://t.co/nCVhOYaujN

— Rachel Issaka, MD, MAS (@IssakaMD) January 19, 2019

“Screening patients with cancer to identify HBV and HCV infection before starting treatment may be warranted to prevent viral reactivation and adverse clinical outcomes,” the researchers concluded. However, “the low rate of undiagnosed HIV infection may not support universal screening of newly diagnosed cancer patients.”

Why have liver cancer death rates skyrocketed in the past 16 years?

GLOBOCAN 2018: Cancer incidence continues to rise.

Source: JAMA Oncology