Chronic hepatitis B infection: Silent threat after cancer treatment
Network - Spring 2013
By Mary Brolley
Preventable cause of deathOften a silent disease, HBV infection affects about 1% of the United States population overall, but infection may be as high as 3% to 9% in high-risk groups.
Major routes of infection are through sexual or direct blood-to-blood contact. Many children in developing countries become infected at birth or during childhood.
People with chronic HBV can be asymptomatic for years. The virus is 50 to 100 times more contagious than HIV and can survive outside the body for up to seven days.
The fact that it often goes undiagnosed can cause problems after an unsuspecting carrier undergoes cancer treatment. The virus can reactivate after treatment is finished, wreaking havoc in the person’s system.
Hwang wants to identify and intervene before these HBV-positive people begin treatment.
“Reactivation after chemotherapy is a preventable cause of death,” she says. “We have effective antiviral therapies to counteract it.”
But how to identify patients who carry the virus and don’t know it? Hwang will begin a study this summer to find out.
The National Cancer Institute-funded study will try to determine which patients should be screened for the disease before they begin cancer treatment.
Help for a global problemHwang’s study aims to test about 4,000 new MD Anderson patients using the most accurate tests available. Those who test negative will receive a letter telling them that.
Those who test positive will get a phone call with a request to come in and see Hwang or one of her colleagues. They might receive antiviral treatment and will be followed throughout their cancer treatment and beyond.
Because there’s an overlap in some of the risk factors, the study will not only screen participants for hepatitis B, but also for hepatitis C and HIV. It will accrue patients over 18 months and run for 24 months.
Hwang’s previous research showed that rates of screening were very low, even among high-risk populations. Patients were most likely to be screened if they had hematological malignancies (blood or lymph cancers like leukemia and lymphoma) or had been treated with regimens including rituximab (Rituxan®).
She doesn’t expect to find high rates of infection. “If we screen about 4,000 people, we might expect to find approximately 150 patients with chronic infection and an additional 300 patients with previous infection (but not the chronic infection) with the virus,” she says. Her goal is to identify patterns among those who test positive, so guidelines for screening will be more effective.
The study’s findings could help physicians and health care workers all over the world.
“We want to collaborate with others. Hepatitis B is a global problem, and there’s such a need for good data,” she says.
“It’s been difficult to get funding, so we’re especially excited about the NCI grant. We need to move the field forward.”