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Chronic hepatitis B infection: Silent threat after cancer treatment

Network - Spring 2013

By Mary Brolley

Jessica Hwang, M.D., is on a mission.

The associate professor in MD Anderson’s Department of General Internal Medicine wants to find out which newly diagnosed cancer patients should be screened for a deadly and contagious virus before they begin treatment.

The virus is hepatitis B (HBV), an infectious inflammatory illness of the liver. Fairly rare in the United States, it’s endemic (multiplying at a steady rate) in China and epidemics (rapidly spreading disease) have occurred in parts of Asia and Africa.

Cancer patients who are chronic carriers of the virus are at risk for reactivation after chemotherapy. Reactivation may cause symptoms that necessitate interruptions in therapy or, in the most serious cases, liver failure and death.

Some of these chronic carriers knew they had the virus but had recovered from it. Others may never have known they were infected.

The good news is that, once detected, patients who are HBV-positive can be treated with effective antiviral therapies at the same time they’re being treated for cancer.

Preventable cause of death

Often 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 problem

Hwang’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.”

© 2014 The University of Texas MD Anderson Cancer Center