Dual or Single Hepatitis B and C Virus Infections in Childhood Cancer Survivors: Long-Term Follow-Up and Effect of Interferon Treatment

Abstract

We conducted a long-term prospective study of 89 cancer survivor children who had acquired hepatitis B virus (HBV) and/or hepatitis C virus (HCV) during treatment for neoplasia, the aim being to evaluate the natural history of the diseases and the effect of interferon (IFN) treatment. Patients were followed up for a median period of 13 years (range, 8 to 20); 46 were infected by HBV, 11 by HCV, and 32 coinfected by HBV and HCV. A spontaneous clearance of hepatitis B surface antigen (HBsAg) occurred more frequently in coinfected patients (19%) than in the HBV-infected (2%; P = .004), with an annual seroconversion rate of 2.1% and 0.2%, respectively (P= .008). Loss of hepatitis Be antigen (HBeAg) occurred in 44% of coinfected and in 28% of HBV-infected patients. Clearance of serum HCV-RNA was observed in 34% and 9%, respectively, of coinfected and HCV-infected patients. Seventeen HBV-infected, 4 HCV-infected, and 16 coinfected patients received -IFN treatment. In the HBV group, 6 patients (35%) cleared serum HBV DNA and seroconverted to anti-HBe; in the HCV-group, none cleared HCV-RNA. In the coinfected group, 1 patient cleared both HBV DNA and HCV-RNA, 6 patients cleared serum HCV-RNA alone, and 1 only HBV DNA and HBeAg. Overall, the diseases showed a mild histological course with no evidence of liver cirrhosis. A reciprocal interference on viral replication between HBV and HCV may occur in coinfected patients. Treatment seems to be effective for selected cases and is justified in view of the uncertain prognosis of the disease in these patients.

Anti‐envelope 1 and 2 immune response in chronic hepatitis C patients: Effects of hepatitis B virus co‐infection and interferon treatment

“…The hepatitis B virus (HBV) and HCV may interfere mutually in viral replication and this mechanism may influence the course of the liver disease and the extent of viral clearance [Liaw, 1995;Crespo et al, 1997;Utili et al, 1999]. At present, there are no data on the behaviour of the anti-E1/E2 antibodies in patients with HBV-HCV co-infection.…”

Sequential analysis of hepatitis B virus core promoter and precore regions in cancer survivor patients with chronic hepatitis B before, during and after interferon treatment

“…Spontaneous and α‐2a interferon (IFN)‐induced HBeAg/anti‐HBe seroconversion is usually preceded by a rise in ALT, which may indicate an attempt by the host immune system to clear HBV. Indeed, several studies have shown that low HBV‐DNA levels and elevated ALT values are predictive of a favourable response to IFN treatment [17–19].…”

Hepatitis B and Hepatitis C viral infection: A Review

“…Furthermore, patients with chronic HBV infection who become superinfected with HCV can undergo seroconversion of hepatitis B e antigen (HBeAg) and HBsAg to respective antibodies (Liaw et al, 1994). In a longitudinal follow-up study of a large series of HBV infected patients carried out by Sheen et al, 200, it was found that the annual incidence of HBsAg seroconversion was 2.08% in coinfected patients compared to 0.43% in patients with HBV monoinfection, and a subsequent study confirmed these results (Utili et al,1999).…”