Chronic hepatitis C virus infections in leukemia survivors: Prevalence, viral load, and severity of liver disease

The natural history of chronic hepatitis C (HCV) infections in long-term le ukemia survivors has not been well characterized. We studied the prevalence of HCV infections, measured HCV RNA levels, and evaluated the severity of liver disease in patients with leukemia who achieved long-term remissions a fter intensive chemotherapy or bone marrow transplantation (BMT). HCV antib ody tests were performed by the enzyme-linked immunosorbent assay (ELISA) a nd positive tests confirmed by the recombinant immunoblot assay (RIBA). HCV RNA levels were measured by the branched DNA (bDNA) assay. Seventy-five le ukemia survivors with 25 or more blood donor exposures were identified. Nin e (12%) were anti-HCV positive. All were infected before 1992 when second g eneration HCV screening tests were implemented, Mean HCV RNA levels were 10 .3 x 10(6) eq/mL versus 3.2 x 10(6) eq/mL (P =.056) in a control group of 2 0 anti-HCV positive immunocompetent individuals of comparable age who were infected twice as long (17.8 +/- 6.5 years v 9.0 +/- 4.4 years in leukemia survivors, P=.001). Liver biopsies were performed on six of the nine anti-H CV positive leukemia survivors. All showed at least moderate portal inflamm ation and half had evidence of bridging fibrosis. We conclude that viral lo ads in anti-HCV positive leukemia survivors are markedly higher than in imm unocompetent controls, Our results suggest that long-term leukemia survivor s with chronic HCV may have more rapidly progressive liver disease than has been previously recognized. (C) 1999 by The American Society of Hematology .