Reactivation of hepatitis B but not hepatitis C in patients with malignant lymphoma and immunosuppressive therapy. A prospective study in 305 patients

Abstract

Backgrounds/aims: The aim of this prospective study was to determine the prevalence of hepatitis B (HBV) and hepatitis C viral (HCV) infection as well as to study the morbidity and mortality of viral reactivations in patients treated with corticosteroid containing chemotherapy.

Methodology: From January 1991 to April 1996, 305 patients admitted for treatment of Hodgkin's disease and non-Hodgkin's lymphoma were tested for HBV, and 181 patients for HCV infection. They were followed-up regularly on a monthly basis with liver biochemistry and viral serology.

Results: The prevalence of HBs antigen and hepatitis C antibody was found to be 3.2% and 16% respectively. There were 9 reactivations of HBV among 8 HBs antigen positive patients (78%), one among 35 HBs antigen negative patients (2.8%) and none in HCV positive patients. In 83% of cases, reactivation was connected to chemotherapy and corticosteroids. The overall death rate of HBV reactivation was 37%; in severe hepatitis it was 60%. All fatal reactivations were in anti-HBe positive patients.

Conclusions: The low prevalence of HCV failed to demonstrate an association between hepatitis C viral infection and lymphoma in Slovenia. Reactivation of HBV infection in HBsAg positive malignant lymphoma patients is a common and often fatal complication of treatment.