ROLE OF SCREENING FOR HEPATITIS-C VIRUS IN CHILDREN WITH MALIGNANT DISEASE AND WHO UNDERGO BONE-MARROW TRANSPLANTATION

BACKGROUND: Children with malignant disease who received multiple bloo d transfusions before the clinical definition of hepatitis C virus (HC V) require evaluation for HCV infection. STUDY DESIGN AND METHODS: The role of HCV infection in 54 children with primary malignant disease w as evaluated in terms of the following aspects: prevalence of HCV infe ction, distribution of HCV subtype, the benefit of screening of blood donors, and the presence of chronic liver disease. The benefit of scre ening for HCV in a subset of patients who underwent bone marrow transp lantation (BMT) was also evaluated. RESULTS: Seventeen patients (31.4% ) of 54 tested were seropositive in a second-generation HCV antibody t est. Thirteen patients (24.0%) were also positive for circulating HCV RNA. HCV subtype 1b and HCV subtype 2b were found in six and two patie nts, respectively. Multiple HCV genotypes were present in two patients . One of these two patients had relatively progressive liver disease. Before the introduction of blood screening with a second-generation HC V antibody test, 15 of 35 patients seroconverted, whereas none of 7 pa tients seroconverted after the screening was used (p = 0.032). For pat ients who underwent BMT, the screening drastically decreased the seroc onversion rate, from 7 of II patients to 0 of 6 (p = 0.016). CONCLUSIO N: A considerable number of children with primary malignant disease wh o received multiple blood transfusions became infected by HCV before H CV screening was used. Patients who underwent BMT were at high risk fo r HCV infection. Screening with a second-generation HCV antibody test has proven to be remarkably beneficial in preventing HCV infection in these children.