Dual or single hepatitis B and C virus infections in childhood cancer survivors: Long-term follow-up and effect of interferon treatment

We conducted a long-term prospective study of 89 cancer survivor children w ho had acquired hepatitis B virus (HBV) and/or hepatitis C virus (HCV) duri ng treatment for neoplasia, the aim being to evaluate the natural history o f the diseases and the effect of interferon (IFN) treatment. Patients were followed up for a median period of 13 years (range, 8 to 20); 46 were infec ted by HBV, 11 by HCV, and 32 coinfected by HBV and HCV. A spontaneous clea rance of hepatitis B surface antigen (HBsAg) occurred more frequently in co infected patients (19%) than in the HBV-infected (2%; P = .004), with an an nual seroconversion rate of 2.1% and 0.2%, respectively(P = .008). Loss of hepatitis Be antigen (HBeAg) occurred in 44% of coinfected and in 28% of HB V-infected patients. Clearance of serum HCV-RNA was observed in 34% and 9%, respectively, of coinfected and HCV-infected patients. Seventeen HBV-infec ted, 4 HCV-infected, and 16 coinfected patients received alpha-IFN treatmen t. In the HBV group, 6 patients (35%) cleared serum HBV DNA and seroconvert ed to anti-HBe; in the HCV-group, none cleared HCV-RNA. In the coinfected g roup, 1 patient cleared both HBV DNA and HCV-RNA, 6 patients cleared serum HCV-RNA alone, and 1 only HBV DNA and HBeAg. Overall, the diseases showed a mild histological course with no evidence of liver cirrhosis, A reciprocal interference on viral replication between HBV and HCV may occur in coinfec ted patients. Treatment seems to be effective for selected cases and is jus tified in view of the uncertain prognosis of the disease in these patients. (C) 1999 by The American Society of Hematology.