Ramsey SD, et al. JAMA Oncol. 2019;doi:10.1001/jamaoncol.2018.6437.

January 17, 2019
2 min read

Undiagnosed HBV, HCV, HIV prevalent in newly diagnosed cancer cases


Ramsey SD, et al. JAMA Oncol. 2019;doi:10.1001/jamaoncol.2018.6437.

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Researchers discovered a substantial proportion of patients with newly diagnosed cancer and concurrent hepatitis C or hepatitis B were unaware of their viral infection and many had no identifiable risk factors, according to a recently published study.

Although the rate was low, some patients also presented with undiagnosed HIV.

“Screening may be especially important now that we've entered the age of immunotherapies for cancer — treatments that may affect cancer patients’ immune systems and alter the course of their viral infections,” Scott D. Ramsey, MD, PhD, lead study author from the Fred Hutchinson Cancer Research Center in Washington said in a press release. “While we don’t know much about the impact of immunotherapies on patients with cancer and hepatitis and other viral infections, oncologists should know as much as possible about the overall health of the people they treat.”

The study comprised 3,051 patients with cancer who underwent testing for HBV, HCV or HIV.

The overall rate of previous HBV infection was 6.5% (95% CI, 5.6-7.4) with 172 patients who were newly diagnosed. The rate of unknown HBV cases was 87.3% (95% CI, 81.8-91.6) and the rate of unknown chronic HBV cases was 42.1% (95% CI, 20.3-66.5).

Previous HBV infection was most common in patients with prostate cancer (12%; 95% CI, 6.4-20) and gastrointestinal cancers other than liver or colorectal (9.4; 95% CI, 6.-13.8). The rates of previous HBV and chronic HBV were similar among patients after excluding those with liver cancer.

The rate of HCV infection was 2.4% (95% CI, 1.9-3) with 22 patients who were newly diagnosed. The rate of unknown HCV was 31% (95% CI, 20.5-43.1). HCV was most common in patients with liver cancer (17.3%; 95% CI, 8.2-30.3).

Thirty-four patients had HIV for an overall rate of 1.1% (95% CI, 0.8-1.6). Two patients were newly diagnosed (5.9% unknown cases; 95% CI, 0.7-19.7).

Many patients had no known infection risk factors, including 54 patients with previous HBV (27.4%; 95% CI, 21.3-34.2), four with chronic HBV (21.1%; 95% CI, 6.1-45.6), 23 with HCV (32.4%; 95% CI, 21.8-44.5), and seven with HIV (20.6%; 95% CI, 8.7-37.9).

“Our results were consistent with [previous] studies, suggesting that substantial portions of HBV and HCV infections prevalent at the time of cancer diagnosis were unknown to patients,” Ramsey and colleagues concluded. “We believe our results warrant consideration of universal testing of patients with newly diagnosed cancer for HBV and HCV infection, particularly if such an approach is shown to be cost-effective.” – by Talitha Bennett

Disclosure: Ramsey has received grants from the National Cancer Institute. Please see the full study for the other authors’ relevant financial disclosures.