Cancer patients undergoing chemotherapy who have Hepatitis B (HBV) infection may be at elevated risk of liver failure from HBV reactivation, resulting in treatment interruptions/delays, hospitalization, even liver transplantation and death. There is conflicting guidance regarding screening for HBV infection, given that the US Center for Disease Control recommends universal screening for all patients receiving cytotoxic or immunosuppressive therapies, whilst ASCO suggests a selective approach.
A screening initiative was set up from November 2010, with the aim of identifying patients with chronic infection and referring them for chemoprophylaxis to prevent re-activation. Patients prior to receiving chemotherapy, were offered HBV and HCV testing after being given information leaflets explaining the rationale and implications. Testing included HBsAg surface antigen, HBcAb core antibody, and for those –ve HBsAg and +ve HBcAb, viral load for HBV was recommended. HCV Abs were also tested. Patients HBsAg +ve, or HBcAb +ve and detectable viral load were referred for consideration of antiviral therapy, as were patients with +ve HCV Abs. Patients with Hepatocellular cancer and known Hepatitis infections were excluded from this analysis.
1353 patients were screened between November 2010 and May 2015. With about 2.2% being positive for HBsAg, 14.8% for HBcAb and 1.2% for HepCAb, however with significant differences for gender and ethnicity. HepBcAb+ve: males 17.19% (99/576), females 12.78% (86/673). HepCAb +ve: Greek Cypriot 0.83% (9/1085), Turkish Cypriot 0% (0/49), Greeks 13.33% (2/15). Further data will be provided on the poster. In a sub-study for HepBcAb +ve but HepBsAg -ve, viral load was negative in 55 and positive in 3 patients. Of interest is that during this period two patients were diagnosed with Hepatitis re-activation, that were not part of this study; both patients had to stop chemotherapy and start anti-viral therapy.
This study confirms the low percentage of Hepatitis B and C infection in the Cyprus population, and that hepatitis re-activation although rare, is a real complication of chemotherapy. Patients born outside Cyprus have a higher incidence of HBV and HCV infections. The results are going to be used to set up local guidelines.
Clinical trial identification
Legal entity responsible for the study
Haris C. Charalambous.
Has not received any funding.
All authors have declared no conflicts of interest.