1292. Changes in Hepatitis C Virus RNA Levels in Cancer Patients Undergoing Chemotherapy or Immunosuppressive Therapy
Session: Poster Abstract Session: Viral Epidemiology
Saturday, October 22, 2011
Room: Poster Hall B1
Background: Patients chronically infected with hepatitis C Virus (HCV) have stable HCV RNA levels that may vary by ~0.5 log IU/ml. Understanding the effects of chemotherapy or immunosuppressive therapy (CIT) on HCV viral load can be helpful in identifying the agents associated with HCV reactivation in cancer patients. We retrospectively evaluated the effect of systemic CIT on HCV RNA levels in cancer patients with chronic HCV infection.

Methods: Medical records of patients with cancer and HCV infection seen at our institution between 01/01/2009 and 12/31/2009 were identified. HCV RNA levels pre- and post-CIT were analyzed. HCV reactivation was defined as an increase in HCV viral load of at least 1 log IU/ml following CIT.

Results: Twenty-two HCV-infected patients with cancer and pre and post-CIT HCV RNA levels were identified. Most patients (15 or 68%) had hematologic malignancies, and none of them were on HCV therapy. Thirty-five cycles of CIT were administered to these patients. Nine episodes of HCV reactivation were noted, with a median elevation of HCV RNA levels of 1.45 (range, 1.06 - 3.59) log IU/ml compared to baseline levels. Viral loads were measured on a median of 2.2 (range, 1 – 16) months after CIT.  Among the 30 agents investigated, significant elevation of HCV RNA levels (>3 log IU/ml from baseline) occurred only after using specific compounds including carmustine, cisplatin, corticosteroids, cytarabine, etoposide, melphalan, and rituximab. Overall, the median ALT peak level at the time of HCV RNA testing was comparable among patients with and without HCV reactivation (113 vs 83 IU/ml, P=0.1); however, in the subset of patients who received a rituximab-containing regimen, there was a trend toward a higher median ALT peak level in patients with reactivation compared to patients who did not reactivate (245 vs 83 IU/ml, P=0.08).

Conclusion: HCV RNA levels vary following administration of specific chemotherapy or immunosuppressive agents; therefore, monitoring HCV viral load before and after treatment with these agents would be helpful in detecting cases of viral reactivation. However, more studies are needed to define the relationship between changes in HCV RNA levels and liver function after CIT in HCV-infected patients with cancer.


Subject Category: V. Virology including clinical and basic studies of viral infections, including hepatitis

Parag Mahale, MBBS, Infectious Department, University of Texas/MD Anderson Cancer Center, Houston, TX and Harrys A. Torres, MD, Department of Infectious Diseases, Infection Control and Employee Health. The University of Texas M. D. Anderson Cancer Center, Houston, TX

Disclosures:

P. Mahale, None

H. A. Torres, None

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