Liver
Hepatitis
Infectious hepatitis is the cause of significant morbidity and mortality after the treatment for childhood cancer, especially in survivors transfused prior to effective blood screening measures for hepatitis B (HBV) and C (HCV).
The incidence of infective hepatitis in cancer survivors varies widely from 6% to 50% across studies, but may likely be in the 20% to 25% range overall.
Chronic hepatitis is associated with an increased risk of cirrhosis and hepatocellular carcinoma.
Hepatocellular carcinoma is largely associated with chronic HBV and HCV infection
Co-infection with HBV and HCV can accelerate liver disease progression as does concomitant immunosuppression or HSCT associated hepatotoxicity.
- Effective hepatitis B screening was implemented in 1972 (North America)
- More aggressive acute clinical course
- Lower rate of chronic infection
- Effective hepatitis C screening was implemented in 1994 (significantly increased risk in patients treated before 1992) (North America)
- Often mild or asymptomatic (most patients have no symptoms)
- Elevated ALT values in 29–79%
- Rate of chronic infection is about 80%
- PCR detection of viral RNA ranges from 70% to 100%
- Prevalence of transfusion related HCV infection (positive EIA or PCR) ranges from 5% to 50% depending on geographic location of the cancer center
- Chronically infected childhood cancer survivors develop progressive fibrosis and cirrhosis at similar rates to adult HCV cohorts, or hemophiliacs co-infected with human immunodeficiency virus (HIV) and HBV.
Below is a link to the website for the class actions settlement for those Canadian patients who acquired hepatitis C through blood transfusions:
Hepatitis C (HCV) January 1, 1986-July 1, 1990 Class Actions Settlement. Please note that the settlement is for the benefit of two main groups:
-
Persons who were infected with HCV for the first time through blood transfusions during the period of January 1, 1986 to July 1, 1990, and certain members of their families;
and -
Persons with certain congenital clotting deficiencies (hemophilia) or Thalassemia Major who contracted HCV and received Blood and blood products in Canada during the period of January 1, 1986 to July 1, 1990, and certain members of their families.
Links:
Hepatitis C testing at Lab Tests Online
COG Survivorship Guidelines: Hepatitis after Treatment for Childhood Cancer
