Prevalence of Hepatitis B Virus, Hepatitis C Virus, and HIV Infection Among Patients With Newly Diagnosed Cancer From Academic and Community Oncology Practices

Abstract

Importance: Universal screening of patients with newly diagnosed cancer for hepatitis B virus (HBV), hepatitis C virus (HCV), and HIV is not routine in oncology practice, and experts disagree about whether universal screening should be performed.

Objective: To estimate the prevalence of HBV, HCV, and HIV infection among persons with newly diagnosed cancer.

Design, setting, and participants: Multicenter prospective cohort study of patients with newly diagnosed cancer (ie, identified within 120 days of cancer diagnosis) at 9 academic and 9 community oncology institutions affiliated with SWOG (formerly the Southwest Oncology Group) Cancer Research Network, a member of the National Clinical Trials Network, with enrollment from August 29, 2013, through February 15, 2017. The data analysis was conducted using data available through August 17, 2017.

Main outcomes and measures: The accrual goal was 3000 patients and the primary end point was the presence of HBV infection (previous or chronic), HCV infection, or HIV infection at enrollment. Patients with previous knowledge of infection as well as patients with unknown viral viral status were evaluated.

Results: Of 3092 registered patients, 3051 were eligible and evaluable. Median (range) age was 60.6 (18.2-93.7) years, 1842 (60.4%) were female, 553 (18.1%) were black, and 558 (18.3%) were Hispanic ethnicity. Screened patients had similar clinical and demographic characteristics compared with those registered. The observed infection rate for previous HBV infection was 6.5% (95% CI, 5.6%-7.4%; n = 197 of 3050 patients); chronic HBV, 0.6% (95% CI, 0.4%-1.0%; n = 19 of 3050 patients); HCV, 2.4% (95% CI, 1.9%-3.0%; n = 71 of 2990 patients); and HIV, 1.1% (95% CI, 0.8%-1.6%; n = 34 of 3045). Among those with viral infections, 8 patients with chronic HBV (42.1%; 95% CI, 20.3%-66.5%), 22 patients with HCV (31.0%; 95% CI, 20.5%-43.1%), and 2 patients with HIV (5.9%; 95% CI, 0.7%-19.7%) were newly diagnosed through the study. Among patients with infections, 4 patients with chronic HBV (21.1%; 95% CI, 6.1%-45.6%), 23 patients with HCV (32.4%; 95% CI, 21.8%-44.5%), and 7 patients with HIV (20.6%; 95% CI, 8.7%-37.9%) had no identifiable risk factors.

Conclusions and relevance: Results of this study found that a substantial proportion of patients with newly diagnosed cancer and concurrent HBV or HCV are unaware of their viral infection at the time of cancer diagnosis, and many had no identifiable risk factors for infection. Screening patients with cancer to identify HBV and HCV infection before starting treatment may be warranted to prevent viral reactivation and adverse clinical outcomes. The low rate of undiagnosed HIV infection may not support universal screening of newly diagnosed cancer patients.

Figure 1.. Flow Diagram for Primary Analysis

Figure 2.. Viral Infection Rates by Type of Virus

Total observed rate is the sum of rates for patients with previously and newly diagnosed viral infection. Total adjusted rates were calculated to reflect the anticipated rate in the US cancer population with similar cancer type, age, race, and ethnicity distribution using Surveillance, Epidemiology, and End Results Program (SEER) incidence data.

Figure 3.. Observed Infection Rates by Type of Virus and Cancer

The whiskers indicate the 95% CIs for the prevalence estimate for each cancer type. GI indicates gastrointestinal.

Figure 4.. Association of Important Predictive Factors and Incidence of Viral Infection

Associations are shown within each virus type in descending order of the odds ratio. Selected questions had results that were poorly defined and they were excluded from the figure including, for chronic hepatitis B virus: injected drugs (0% for present vs 0.6% for absent; odds ratio [OR], 0; 95% CI, 0-6.12; P > .99); high-risk occupation (0% vs 0.7%; OR, 0; 95% CI, 0-3.13; P = .63); sexual contact with HIV-positive person (0% vs 0.6%; OR, 0; 95% CI, 0-17.64; P > .99); blood transfusion between 1978 and 1985 (0% vs 0.6%; OR, 0; 95% CI, 0-5.28; P > .99); and completed the hepatitis B virus vaccine (≥3 doses) (0% vs 0.7%; OR, 0; 95% CI, 0-2.53; P = .39). For HIV, the following observations are not shown: blood transfusion between 1978 and 1985 (0% vs 1.2%; OR, 0; 95% CI, 0-2.65; P = .40) and exchanged sex for drugs or money (0% vs 1.2%; OR, 0; 95% CI, 0-8.80; P > .99). HBV indicates hepatitis B virus; HCV, hepatitis C virus; MSM, men who have sex with men; STD, sexually transmitted disease.