title: The epidemiology of chronic hepatitis C infection in survivors of childhood cancer: an update of the St Jude Children's Research Hospital hepatitis C seropositive cohort.
abstract: Childhood cancer survivors transfused before 1992 are at risk for chronic hepatitis C (HCV) infection. In 1995, St Jude Children's Research Hospital initiated an epidemiologic study of childhood cancer survivors with transfusion-acquired HCV. Of the 148 survivors with HCV confirmed by second-generation enzyme immunoassay, 122 consented to participate in the study. Their current median age is 29 years (range, 9 to 47 years). At enrollment, polymerase chain reaction (PCR) testing indicated chronic infection in 81.1%; genotype 1 was the most common viral genotype. Liver biopsy in 60 patients at a median of 12.4 years from the diagnosis of malignancy showed mild (28.8%) or moderate (35.6%) fibrosis; 13.6% had cirrhosis. Elevated body mass index was associated with histologic findings of increased steatosis (P=.008). Antimetabolite chemotherapy exposure was associated with early progression of fibrosis. Significant quality-of-life deficits were observed in noncirrhotic adult survivors. Antiviral therapy resulted in clearance of infection in 17 (44%) of 38 patients to date. Six patients have died; 1 patient with decompensated cirrhosis died of variceal bleeding. Despite a young age at HCV infection, the progression of liver disease in childhood cancer survivors is comparable to that seen in adults.
authors.affiliation: Department of Hematology-Oncology, St Jude Children's Research Hospital, Memphis, TN 38105-2794, USA.
authors.forename: Sharon
authors.initials: S
authors.lastname: Castellino
authors.forename: Shelly
authors.initials: S
authors.lastname: Lensing
authors.forename: Caroline
authors.initials: C
authors.lastname: Riely
authors.forename: Shesh N
authors.initials: SN
authors.lastname: Rai
authors.forename: Rene
authors.initials: R
authors.lastname: Davila
authors.forename: Randall T
authors.initials: RT
authors.lastname: Hayden
authors.forename: Jackie
authors.initials: J
authors.lastname: Fleckenstein
authors.forename: Mark
authors.initials: M
authors.lastname: Levstik
authors.forename: Shari
authors.initials: S
authors.lastname: Taylor
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Dean
authors.forename: Sarah
authors.initials: S
authors.lastname: Kippenbrock
authors.forename: Jennifer
authors.initials: J
authors.lastname: Pope
authors.forename: Jeanne
authors.initials: J
authors.lastname: Carr
authors.forename: Donald K
authors.initials: DK
authors.lastname: Strickland
authors.forename: Melissa M
authors.initials: MM
authors.lastname: Hudson
mesh_terms: D000328:Adult; D017668:Age of Onset; D000428:Alcohol Drinking; D002648:Child; D015331:Cohort Studies; D005006:Ethnicity; D005260:Female; D005500:Follow-Up Studies; D006526:Hepatitis C / Q000453:epidemiology*; D006801:Humans; D008297:Male; D009369:Neoplasms / Q000145:classification / Q000150:complications* / Q000401:mortality*; D012189:Retrospective Studies; D012307:Risk Factors; D017741:Survivors; D013997:Time Factors