Hepatitis B and Hepatitis C Co-Infection in Patients with Hematological Malignancies

Coinfection with hepatitis B virus (HBV) and hepatitis C virus (HCV) in immunocompromised patients (pts) with hematological malignancies is not well-studied problem. Early recognition of HBV and HCV infectioning incidence in such pts is difficult due to influence of cytostatic and immunosuppressive therapy and possible mutual HBV or HCV inhibitions. Independence of HBV and HCV infection events has to be discussed.

To determine the prevalence of HBV and HCV co-infection in pts with hematological malignancies to check the possible correlation between the incidence of the infections.

All 265 patients treated in hematology department during 2004–2006 years were prospectively continuously monitored and examined for markers HBV and HCV (HBsAg, anti-HCV, DNA HBV, RNA HCV, HBeAg, anti-HBs, anti-HBc, anti-HBe) in serum, plazma, blood cells, bone marrow, cerebrospinal fluid) and clinico-biochemical symptoms of liver dysfunction were registered approximately every 3 weeks until 2008 year. Liver biopsy was performed on 64 pts in 2004–2006 yy, 23 pts esch with HBV and HCV immunohistology. Approximately 80% of pts were with acute leukemias (AL) and aplastic anemias (AA). Male; 47% (n=125), female; 53% (n=140). The median age was 38 years (range, 15 to 79).

At the beginning of treatment and monitoring 17 of 265 pts (6.4%) had positive markers of HCV and the number of pts with positive markers of HCV increased up to 70 (26%) to the end of monitoring, and for HBV markers increased from 23 pts (8.7%) to 174 pts (65.3%). We found, that many pts were co-infected with HBV and HCV, and their total number increased from 5 pts (1,9%) äî 37 pts (14%). Positive tests of HBV and HCV co-infection was found in 57 pts of 265, that is 32.8% of 174 HBV-positive pts and 81.4% of 70 HCV-positive pts, odds ratio (OR=2.9) (95%CI =1.5–5.7), xi square significance p=0.0012. More complicate longitude analysis did not show that the incidence rate of second infection is significantly higher than the first. That means that the correlation between first and second infections is still questionable. Coinfection with HBV and HCV resulted in clinical presentation of hepatitis B and/or hepatitis C in most cases and cumulative incidence rate rises up to 100% at 630 day after the first appearance of any positive marker.

The high prevalence of HBV and HCV coinfection of pts with hematological malignancies is attributed to common risk factors for infection transmission after transfusions of blood components and parenteral medical procedures. For pts with hematological malignancies after first detection of positive test for single marker of HBV and/or HCV it is very reasonable to intensify the monitoring of HBV and HCV markers and to follow clinical signs.

No relevant conflicts of interest to declare.