Acute exacerbation and reactivation of chronic hepatitis C virus infection in cancer patients

Background & Aims: Data on acute exacerbation and reactivation of chronic hepatitis C virus (HCV) infection following chemotherapy are very limited. We sought to characterize the episodes of acute exacerbation and viral reactivation of HCV infection in cancer patients. Methods: The medical records of HCV-infected patients seen at our institution (2008-2009) were analyzed retrospectively. Acute exacerbation was defined as greater than 3-fold increase in serum level of alanine aminotransferase, and viral reactivation as ≥1 log₁₀ IU/ml increase of HCV viral load following chemotherapy. Results: Acute exacerbation occurred in 33 (11%) of 308 patients with proven HCV infection. Patients with acute exacerbation more often had underlying hematological malignancies (73% vs. 29%; p <0.001) and lymphopenia (6% vs. 0%; p = 0.01) than patients without it. In multivariate analysis, underlying hematological malignancies (p = 0.02; odds ratio, 3.2; 95% confidence interval, 1.2-8.7) and use of rituximab (p = 0.004; odds ratio, 4.2; 95% confidence interval, 1.6-10.9) were associated with acute exacerbation. Patients with acute exacerbation received higher median cumulative dose of rituximab than those without exacerbation. Discontinuation of chemotherapy due to liver dysfunction was more common in patients with acute exacerbation than in patients without it (45% vs. 11%; p <0.001). Eight (36%) of 22 patients with known pre- and post-chemotherapy viral load had viral reactivation. Conclusions: Acute exacerbation and reactivation of chronic HCV infection occur often after chemotherapy. Liver dysfunction can lead to discontinuation of potentially life-saving chemotherapy in nearly one-half of the patients with exacerbation of HCV infection.