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.
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.
Castellino
Sharon
S
Department of Hematology-Oncology, St Jude Children's Research Hospital, Memphis, TN 38105-2794, USA.
Lensing
Shelly
S
Riely
Caroline
C
Rai
Shesh N
SN
Davila
Rene
R
Hayden
Randall T
RT
Fleckenstein
Jackie
J
Levstik
Mark
M
Taylor
Shari
S
Dean
Patrick J
PJ
Kippenbrock
Sarah
S
Pope
Jennifer
J
Carr
Jeanne
J
Strickland
Donald K
DK
Hudson
Melissa M
MM
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