Prevalence of hepatitis B and C and sensibility of a selective screening questionnaire in patients receiving chemotherapy for solid tumors
Mathilde Brasseur, Alexandra Heurgué-Berlot, Coralie Barbe, Cloé Brami, Jean-Baptiste Rey, Juliette Vella-Boucaud, Fadia Dabouz, Gaëtan Deslée, Florent Grange, Julien Volet, Olivier Bouché, Mathilde Brasseur, Alexandra Heurgué-Berlot, Coralie Barbe, Cloé Brami, Jean-Baptiste Rey, Juliette Vella-Boucaud, Fadia Dabouz, Gaëtan Deslée, Florent Grange, Julien Volet, Olivier Bouché
Abstract
Background: Reactivation of hepatitis B or C virus can occur in patients undergoing chemotherapy. Recommendations for selective or systematic hepatitis B virus testing prior chemotherapy for solid tumors differ. The primary aim was to determine the seroprevalence of hepatitis B or C in a low endemic country. The second objective was to assess the relevance of a questionnaire on hepatitis B/C risk factors to consider a selective screening.
Methods: Patients were prospectively tested for hepatitis B/C markers. HBs antigen positive patients and isolated anti-HBc positive patients with detectable viral load received antiviral preventive treatment. Patients or physicians completed the questionnaire on infection risk factors.
Results: Among the 450 patients included, 388 were tested for all serological markers and had gastrointestinal (63.7%), lung (31.2%) and skin (4.6%) cancers. The prevalence of subjects exposed to hepatitis B virus was 8.5% (33/388). One patient tested positive for HBs antigen and received preventive treatment. Prevalence of subjects exposed to hepatitis C was 1.3% (5/388). The questionnaire sensitivity was 45.5%, 100% and 50% for detecting carriers of hepatitis B, C and one or the other, respectively.
Conclusions: Seroprevalence of hepatitis B was low. Selective screening with the questionnaire was insufficiently sensitive. Systematic screening with serological tests prior to chemotherapy in patients with solid tumors is therefore relevant.
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References
- Institut de Veille Sanitaire (InVS). Prévalence des hépatites B et C en France en 2004. (2007, accessed 17 September 2014)
- Lok AS, Liang RH, Chiu EK, et al. Reactivation of hepatitis B virus replication in patients receiving cytotoxic therapy. Report of a prospective study. Gastroenterology. 1991;100(1):182–188. doi: 10.1016/0016-5085(91)90599-G.
- Yeo W, Chan PK, Zhong S, et al. Frequency of hepatitis B virus reactivation in cancer patients undergoing cytotoxic chemotherapy: a prospective study of 626 patients with identification of risk factors. J. Med. Virol. 2000;62(3):299–307. doi: 10.1002/1096-9071(200011)62:3<299::AID-JMV1>;2-0.
- Vento S, Cainelli F, Mirandola F, et al. Fulminant hepatitis on withdrawal of chemotherapy in carriers of hepatitis C virus. Lancet. 1996;347(8994):92–93. doi: 10.1016/S0140-6736(96)90212-3.
- Zuckerman E, Zuckerman T, Douer D, et al. Liver dysfunction in patients infected with hepatitis C virus undergoing chemotherapy for hematologic malignancies. Cancer. 1998;83(6):1224–1230. doi: 10.1002/(SICI)1097-0142(19980915)83:6<1224::AID-CNCR23>;2-6.
- Yeo W, Chan PKS, Hui P, et al. Hepatitis B virus reactivation in breast cancer patients receiving cytotoxic chemotherapy: a prospective study. J. Med. Virol. 2003;70(4):553–561. doi: 10.1002/jmv.10430.
- Yeo W, Zee B, Zhong S, et al. Comprehensive analysis of risk factors associating with Hepatitis B virus (HBV) reactivation in cancer patients undergoing cytotoxic chemotherapy. Br. J. Cancer. 2004;90(7):1306–1311. doi: 10.1038/sj.bjc.6601699.
- Ling WHY, Soe PP, Pang ASL, et al. Hepatitis B virus reactivation risk varies with different chemotherapy regimens commonly used in solid tumours. Br. J. Cancer. 2013;108(10):1931–1935. doi: 10.1038/bjc.2013.225.
- Liver EAFTSOT. EASL clinical practice guidelines: Management of chronic hepatitis B virus infection. J. Hepatol. 2012;57(1):167–185. doi: 10.1016/j.jhep.2012.02.010.
- Lok ASF, McMahon BJ. Chronic hepatitis B: update 2009. Hepatol. Baltim. Md. 2009;50(3):661–662. doi: 10.1002/hep.23190.
- Liaw Y-F, Kao J-H, Piratvisuth T, et al. Asian-Pacific consensus statement on the management of chronic hepatitis B: a 2012 update. Hepatol. Int. 2012;6(3):531–561. doi: 10.1007/s12072-012-9365-4.
- Weinbaum CM, Williams I, Mast EE et al. Recommendations for identification and public health management of persons with chronic hepatitis B virus infection. MMWR Recomm. Rep. Morb. Mortal. Wkly. Rep. Recomm. Rep. Cent. Dis. Control 2008; 57(RR-8):1–20.
- Sorrell MF, Belongia EA, Costa J, et al. National Institutes of Health Consensus Development Conference Statement: management of hepatitis B. Ann. Intern. Med. 2009;150(2):104–110. doi: 10.7326/0003-4819-150-2-200901200-00100.
- Hwang JP, Fisch MJ, Lok AS-F, et al. Trends in hepatitis B virus screening at the onset of chemotherapy in a large US cancer center. BMC Cancer. 2013;13:534. doi: 10.1186/1471-2407-13-534.
- Lee RSM, Bell CM, Singh JM, et al. Hepatitis B screening before chemotherapy: a survey of practitioners’ knowledge, beliefs, and screening practices. J. Oncol. Pract. Am. Soc. Clin. Oncol. 2012;8(6):325–328. doi: 10.1200/JOP.2012.000597.
- Artz AS, Somerfield MR, Feld JJ, et al. American Society of Clinical Oncology provisional clinical opinion: chronic hepatitis B virus infection screening in patients receiving cytotoxic chemotherapy for treatment of malignant diseases. J. Clin. Oncol. Off. J. Am. Soc. Clin. Oncol. 2010;28(19):3199–3202. doi: 10.1200/JCO.2010.30.0673.
- Baden LR, Bensinger W, Angarone M, et al. Prevention and treatment of cancer-related infections. J. Natl. Compr. Cancer Netw. JNCCN. 2012;10(11):1412–1445.
- Dreyling M, Ghielmini M, Marcus R, et al. Newly diagnosed and relapsed follicular lymphoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann. Oncol. Off. J. Eur. Soc. Med. Oncol. ESMO. 2011;22(Suppl 6):vi59–63.
- Alexopoulos CG, Vaslamatzis M, Hatzidimitriou G. Prevalence of hepatitis B virus marker positivity and evolution of hepatitis B virus profile, during chemotherapy, in patients with solid tumours. Br. J. Cancer. 1999;81(1):69–74. doi: 10.1038/sj.bjc.6690652.
- Kose S, Olmezoglu A, Gozaydin A, et al. Seroprevalence of hepatitis B and C among oncology patients in Turkey. J. Health Popul. Nutr. 2011;29(6):652–655.
- Oguz A, Aykas F, Unal D, et al. Hepatitis B and C seroprevalence in solid tumors - necessity for screening during chemotherapy. Asian Pac. J. Cancer Prev. APJCP. 2014;15(3):1411–1414. doi: 10.7314/APJCP.2014.15.3.1411.
- Institut de Veille Sanitaire (InVS). Prevalence, morbidity and mortality associated with chronic hepatitis B and C in the French hospitalized population (2004–2011). (2013, accessed 17 September 2014)
- Day FL, Karnon J, Rischin D. Cost-effectiveness of universal hepatitis B virus screening in patients beginning chemotherapy for solid tumors. J. Clin. Oncol. Off. J. Am. Soc. Clin. Oncol. 2011;29(24):3270–3277. doi: 10.1200/JCO.2011.35.1635.
- Yeo W, Lam KC, Zee B, et al. Hepatitis B reactivation in patients with hepatocellular carcinoma undergoing systemic chemotherapy. Ann. Oncol. Off. J. Eur. Soc. Med. Oncol. ESMO. 2004;15(11):1661–1666. doi: 10.1093/annonc/mdh430.
- Chang M-H. Hepatitis B virus infection. Semin. Fetal. Neonatal Med. 2007;12(3):160–167. doi: 10.1016/j.siny.2007.01.013.
- Institut de Veille Sanitaire (InVS). BEH 22/98 Stratégie de dépistage de l’hépatite C en population générale dans les centres d’examens de santé. Dispositif de veille sanitaire pour la coupe du monde de football, en 1998. (1998, accessed 17 September 2014)
- Sypsa V, Hadjipaschali E, Hatzakis A. Prevalence, risk factors and evaluation of a screening strategy for chronic hepatitis C and B virus infections in healthy company employees. Eur. J. Epidemiol. 2001;17(8):721–728. doi: 10.1023/A:1015671627577.
- McQuillan GM, Townsend TR, Johannes CB, et al. Prevention of perinatal transmission of hepatitis B virus: the sensitivity, specificity, and predictive value of the recommended screening questions to detect high-risk women in an obstetric population. Am. J. Epidemiol. 1987;126(3):484–491.
- Centers for Disease Control and Prevention DVH - Viral Hepatitis - Hepatitis Risk Assessment. (accessed 17 September 2014)
- Widespread vs. Selective Screening for Hepatitis B Infection Prior to Chemotherapy. (accessed 17 September 2014)
Source: PubMed