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Category: Volume 08 Issue 01 January 2020
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Title: Seropositivity of Hepatitis and Cancer Management-Review and Recommendations

Authors: Prof. Subbiah Shanmugam, Prof. Sujay Susikar, Rajeswaran Ayyanar

 DOI: https://dx.doi.org/10.18535/jmscr/v8i1.76

Abstract

Background: Hepatitis virus reactivation is one of the troublesome and preventable causes of mortality and morbidity in oncology patients. It causes significant morbidity either directly as liver injury or indirectly by delaying   chemotherapy or definitive treatment. We started the research to find the cause of hepatitis virus (hepatitis B & hepatitis C) positivity, on subsequent admissions in patients who were previously negative by the same serological test. We conducted the research to find out the possible mode of acquisition of hepatitis virus

Objectives

  1. To emphasize the importance of serological test during every admission  particularly in a cancer ward and to standardize the protocol
  2. Preventing hepatitis virus reactivation related morbidity and mortality.
  3. To ensure safety of patients and medical personal.
  4. To enhance safety during blood transfusion.

Materials and Methods: Patients admitted during the period of January 2017 to March2 019 in department of surgical oncology, government Royapettah hospital who were negative for hepatitis B virus (HBV) /hepatitis C virus (HCV) on first or initial admission and treated after that with blood transfusion, chemotherapy, interventional procedures were included. Patients who became positive on routine serology were reaffirmed by specific tests like ELISA, RNA/DNA tests. Along with that liver function test, radiological assessment of liver was done and morbidity and mortality   recorded.

Results: Among the seroconverted patients, 60(68%) were found to be positive for HBV and 26(29.5%) were HCV positive. Two patients were (2.27%) positive for both HBV&HCV.  We found seroconversion   in 38 patients. Female to male ratio was 1:0.9. In our study we found that 79% patients were between the age of 30 to 60. We noted that 32 (84.2%) patients with seroconversion was post chemotherapy. There were 11 patients (28 %) who got blood transfusion. In patients with seroconversion   Adriamycin, CDDP, 5-FU based chemotherapy was used in 9,19,9 patients respectively. Musculoskeletal sarcoma and GIT cancers were most frequent among the seroconverted patients. During our hospital admissions 3 patients died of acute fulminant hepatic failure (mortality rate of 39 per 1000/year), 1 patient required ICU admission and recovered.  Half (n=19) of patients having fibro scan above 12.5 kilopascals probably indicating that these patients were in a chronic hepatitis state.

Conclusion: In our study we frequently encountered patients who were seropositive after treatment. It was found to be related to chemotherapy induced immunosuppression causing hepatitis virus reactivation.

We used rapid card test to detect HBV and HCV antibody, which has very low sensitivity and not recommended for routine screening. Sensitivity and specificity of third generation EIA is 99% and is recommended for routine screening (32).

As an oncologist it is important to be aware about this potential life threatening and treatable condition. Timely administration of antiviral prophylaxis will reduce the viral reactivation related fulminant hepatic failure and death.

  1. The serological tests recommended to detect HBV, in descending order are HBV-DNA, HBs Ag and HB e Ag 
  2. For HCV it is ideal to do HCV antibody as a screening test, followed by EIA and HCV RNA as a confirmative test.

Keywords: Hepatitis, HBV and HCV reactivation, chemotherapy induced hepatitis virus reactivation.

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Corresponding Author

Prof. Sujay Susikar

Associate Professor, Department of Surgical Oncology, Government Royapettah Hospital, Chennai, India