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Original Investigation
January 17, 2019

Prevalence of Hepatitis B Virus, Hepatitis C Virus, and HIV Infection Among Patients With Newly Diagnosed Cancer From Academic and Community Oncology Practices

Author Affiliations
  • 1Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, Seattle, Washington
  • 2Fred Hutchinson Cancer Research Center, Seattle, Washington
  • 3SWOG (formerly the Southwest Oncology Group) Statistics and Data Management Center, Seattle, Washington
  • 4Rogel Cancer Center, University of Michigan, Ann Arbor
  • 5Cancer Therapy and Evaluation Program, National Cancer Institute, Bethesda, Maryland
  • 6Division of Gastroenterology, University California San Diego Moores Cancer Center, San Diego
  • 7Department of General Internal Medicine, University of Texas, MD Anderson Cancer Center, Houston
  • 8Department of Oncology, Kaiser Permanente–Lonetree, Lonetree, Colorado
  • 9Department of Oncology, Kaiser Permanente Medical Center, Oakland, California
  • 10National Cancer Institute Community Oncology Research Program of the Carolinas, Greenville Health System National Cancer Institute Community Oncology Research Program, Greenville, South Carolina
  • 11Gulf South Minority–Underserved National Cancer Institute Community Oncology Research Program, Louisiana State University Health Sciences Center, Shreveport
  • 12Division of Hematology/Oncology, Herbert Irving Comprehensive Cancer Center, Columbia University, New York, New York
JAMA Oncol. Published online January 17, 2019. doi:10.1001/jamaoncol.2018.6437
Key Points

Question  What is the prevalence of hepatitis B virus, hepatitis C virus, and HIV infection among patients with newly diagnosed cancer?

Findings  In this cohort study of 3051 patients with newly diagnosed cancer, infection rates were 6.5% for previous hepatitis B virus, 0.6% for chronic hepatitis B virus, 2.4% for hepatitis C virus, and 1.1% for HIV. Among patients with viral infections, 42.1% of patients with chronic hepatitis B virus, 31.0% of patients with hepatitis C virus, and 5.9% of patients with HIV were newly diagnosed through the study.

Meaning  Screening patients with newly diagnosed cancer to identify hepatitis B virus and hepatitis C virus infection before starting treatment may be warranted to prevent viral reactivation and adverse clinical outcomes; universal screening for HIV infection may not be warranted.

Abstract

Importance  Universal screening of patients with newly diagnosed cancer for hepatitis B virus (HBV), hepatitis C virus (HCV), and HIV is not routine in oncology practice, and experts disagree about whether universal screening should be performed.

Objective  To estimate the prevalence of HBV, HCV, and HIV infection among persons with newly diagnosed cancer.

Design, Setting, and Participants  Multicenter prospective cohort study of patients with newly diagnosed cancer (ie, identified within 120 days of cancer diagnosis) at 9 academic and 9 community oncology institutions affiliated with SWOG (formerly the Southwest Oncology Group) Cancer Research Network, a member of the National Clinical Trials Network, with enrollment from August 29, 2013, through February 15, 2017. The data analysis was conducted using data available through August 17, 2017.

Main Outcomes and Measures  The accrual goal was 3000 patients and the primary end point was the presence of HBV infection (previous or chronic), HCV infection, or HIV infection at enrollment. Patients with previous knowledge of infection as well as patients with unknown viral viral status were evaluated.

Results  Of 3092 registered patients, 3051 were eligible and evaluable. Median (range) age was 60.6 (18.2-93.7) years, 1842 (60.4%) were female, 553 (18.1%) were black, and 558 (18.3%) were Hispanic ethnicity. Screened patients had similar clinical and demographic characteristics compared with those registered. The observed infection rate for previous HBV infection was 6.5% (95% CI, 5.6%-7.4%; n = 197 of 3050 patients); chronic HBV, 0.6% (95% CI, 0.4%-1.0%; n = 19 of 3050 patients); HCV, 2.4% (95% CI, 1.9%-3.0%; n = 71 of 2990 patients); and HIV, 1.1% (95% CI, 0.8%-1.6%; n = 34 of 3045). Among those with viral infections, 8 patients with chronic HBV (42.1%; 95% CI, 20.3%-66.5%), 22 patients with HCV (31.0%; 95% CI, 20.5%-43.1%), and 2 patients with HIV (5.9%; 95% CI, 0.7%-19.7%) were newly diagnosed through the study. Among patients with infections, 4 patients with chronic HBV (21.1%; 95% CI, 6.1%-45.6%), 23 patients with HCV (32.4%; 95% CI, 21.8%-44.5%), and 7 patients with HIV (20.6%; 95% CI, 8.7%-37.9%) had no identifiable risk factors.

Conclusions and Relevance  Results of this study found that a substantial proportion of patients with newly diagnosed cancer and concurrent HBV or HCV are unaware of their viral infection at the time of cancer diagnosis, and many had no identifiable risk factors for infection. Screening patients with cancer to identify HBV and HCV infection before starting treatment may be warranted to prevent viral reactivation and adverse clinical outcomes. The low rate of undiagnosed HIV infection may not support universal screening of newly diagnosed cancer patients.

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