Incidence of hepatitis virus infection and severe liver dysfunction in patients receiving chemotherapy for hematologic malignancies

Hepatitis virus infection through virus reactivation has a high risk of mor tality in patients with hematological malignancies receiving chemotherapy. We examined the incidence of both hepatitis B virus (HBV) and hepatitis C v irus (HCV) infection and severe liver dysfunction (alanine aminotransferase > ten times the normal upper limit and total bilirubin >5 mg/dl) during ch emotherapy in 268 patients with hematological malignancies. Eight patients (3.0%) were infected with HBV and 22 patients (8.2%) were infected with HCV . One patient (0.4%) was infected with both HBV and HCV. HBV- or HCV-infect ed patients showed severe liver dysfunction at a significantly higher incid ence than non-infected patients (11/31 (35.5%) vs. 0/237 (0%), p <0.0001). Furthermore, the incidence of severe liver dysfunction in HBV-infected pati ents was significantly higher than in HCV-infected patients (6/8 (75.0%) vs . 4/22 (18.2%), p <0.01). Three of eight HBV-infected patients were initial ly negative for hepatitis B surface antigen (HBsAg) by latex agglutination and became positive for HBsAg during chemotherapy. Furthermore, all three p atients developed severe liver dysfunction and two developed fatal fulminan t hepatitis. From an examination of the original stock of serum samples bef ore chemotherapy, two patients were found to be positive for HBV-DNA by pol ymerase chain reaction (PCR). Although post-transfusion HBV infection was s uspected in the one remaining patient, the cause of HBV infection could not be clarified due to the impossibility of examination in blood donors. Sinc e HBV-infected patients develop severe liver dysfunction at a higher incide nce than either patients not infected with virus or HCV-infected patients b efore chemotherapy for hematological malignancies, it is recommended that H BV-DNA should be tested by PCR to detect HBV marker-negative carriers and l iver function tests should be carefully monitored.