Many Hepatitis Infections Go Undiagnosed in Cancer Patients

Anesthesiology News

An alarmingly high rate of patients with cancer have undiagnosed acute and chronic hepatitis.

Investigators from SWOG Cancer Research Network, an international cancer clinical trials group funded by the National Cancer Institute, found that a substantial portion of newly diagnosed cancer patients with HBV or HCV were unaware of their viral infection. Many had no identifiable risk factors for these infections, such as injection drug use (JAMA Oncol 2019 Jan 25.

Their findings:

• 6.5% of patients had past HBV;
• 0.6% had chronic HBV;
• 2.4% had HCV; and
• 1.1% had HIV.

Of note, a substantial proportion of patients with past (87.3%) and chronic (42.1%) HBV infections were undiagnosed prior to the study screening, as well as a large proportion of people with HCV infection (31%).

There was no evidence of large numbers of undiagnosed HIV infections, although 5.9% of people with HIV were newly diagnosed through the study.

Many patients had no risk factors for their viral infections: 27.4% for past HBV, 21.1% of patients with chronic HBV, 32.4% with HCV and 20.6% with HIV.

“While our results don’t suggest that universal HIV screening is necessary for cancer patients, they do provide new evidence to inform a discussion in the oncology community about whether we should require hepatitis screenings,” said Scott Ramsey, MD, PhD, a SWOG investigator and the director of the Hutchinson Institute for Cancer Outcomes Research at Fred Hutchinson Cancer Research Center, in Seattle. “Screening may be especially important now that we’ve entered the age of immunotherapies for cancer—treatments that may affect cancer patients’ immune systems and alter the course of their viral infections. While we don’t know much about the impact of immunotherapies on patients with cancer and hepatitis and other viral infections, oncologists should know as much as possible about the overall health of the people they treat.”

There is some evidence that anti-CD20 therapies, such as the drug rituximab, as well as hematopoietic cell transplantation—both treatments for lymphoma and leukemia—can cause some infection-causing viruses to reactivate and multiply.

“As a cancer patient, or physician, I would want to know the results of a hepatitis screening test,” Dr. Ramsey said. “The presence of a potentially life-threatening infection could guide care in very important ways. In medicine, more knowledge is always better.”

Joseph Unger, PhD, a SWOG biostatistician also based at Fred Hutchinson, said universal screening for hepatitis is an important debate for the cancer care and research community to engage in, especially given the large proportion of undiagnosed hepatitis cases shown in this study.

“From a public health perspective, chronic hepatitis B and hepatitis C are a significant challenge, since these infections affect millions of Americans, including many patients with cancer,” Dr. Unger said. “Testing cancer patients for these diseases could catch a lot of undiagnosed cases and help modify their cancer care to improve outcomes.”