Prevalence and natural history of hepatitis C infection in patients cured of childhood leukemia.
The aim of this study was to ascertain prevalence and natural history of hepatitis C virus (HCV) infection in a large cohort of patients cured of childhood leukemia who had been followed prospectively for liver disease for at least 10 years since chemotherapy withdrawal: 114 consecutive patients entered the study. Liver function tests and ultrasonography were used to assess presence of liver disease. Patients were tested for antibody to HCV and for serum HCV-RNA at the end of chemotherapy and at the end of follow-up. At chemotherapy withdrawal, 56 patients (49%) were HCV-RNA positive, often without detectable anti-HCV, and in these cases, transaminase levels were more elevated during (P = .08) and after (P = .04) chemotherapy compared with HCV-RNA negative cases. Patients were then followed-up 13 to 27 years (mean, 17) after chemotherapy withdrawal. During this period, 38 initially anti-HCV negative patients seroconverted to anti-HCV and 17 initially anti-HCV positive cases lost reactivity. Forty patients were persistently HCV-RNA positive in serum, while 16 initially viremic patients became HCV-RNA negative during follow-up. At the end of the observation period, a persistent transaminase elevation was detected only in four HCV-RNA positive and anti-HCV positive cases, while no patient developed signs or symptoms of decompensated liver disease. Thus, hepatitis C was a frequent finding in long-term survivors after chemotherapy. It was associated with an atypical serologic profile and did not cause severe liver impairment over a period of 13 to 27 years.
Locasciulli
A
A
Clinica Pediatrica Università di Milano, Department of Pediatric Hematology, S. Gerardo Hospital, Monza, Italy.
Testa
M
M
Pontisso
P
P
Benvegnù
L
L
Fraschini
D
D
Corbetta
A
A
Noventa
F
F
Masera
G
G
Alberti
A
A
D000293:Adolescent; D000328:Adult; D000410:Alanine Transaminase / Q000097:blood; D015415:Biomarkers / Q000032:analysis; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D005838:Genotype; D016174:Hepacivirus / Q000235:genetics; D006526:Hepatitis C / Q000453:epidemiology* / Q000503:physiopathology* / Q000635:transmission; D018937:Hepatitis C Antibodies / Q000032:analysis; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000150:complications / Q000628:therapy*; D015995:Prevalence; D011446:Prospective Studies; D012367:RNA, Viral / Q000032:analysis; D014766:Viremia / Q000150:complications / Q000276:immunology
D015415:Biomarkers; D018937:Hepatitis C Antibodies; D012367:RNA, Viral; D000410:Alanine Transaminase