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JAMA Oncol. 2019 Jan 17. doi: 10.1001/jamaoncol.2018.6437. [Epub ahead of print]

Prevalence of Hepatitis B Virus, Hepatitis C Virus, and HIV Infection Among Patients With Newly Diagnosed Cancer From Academic and Community Oncology Practices.

Author information

1
Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, Seattle, Washington.
2
Fred Hutchinson Cancer Research Center, Seattle, Washington.
3
SWOG (formerly the Southwest Oncology Group) Statistics and Data Management Center, Seattle, Washington.
4
Rogel Cancer Center, University of Michigan, Ann Arbor.
5
Cancer Therapy and Evaluation Program, National Cancer Institute, Bethesda, Maryland.
6
Division of Gastroenterology, University California San Diego Moores Cancer Center, San Diego.
7
Department of General Internal Medicine, University of Texas, MD Anderson Cancer Center, Houston.
8
Department of Oncology, Kaiser Permanente-Lonetree, Lonetree, Colorado.
9
Department of Oncology, Kaiser Permanente Medical Center, Oakland, California.
10
National Cancer Institute Community Oncology Research Program of the Carolinas, Greenville Health System National Cancer Institute Community Oncology Research Program, Greenville, South Carolina.
11
Gulf South Minority-Underserved National Cancer Institute Community Oncology Research Program, Louisiana State University Health Sciences Center, Shreveport.
12
Division of Hematology/Oncology, Herbert Irving Comprehensive Cancer Center, Columbia University, New York, New York.

Abstract

Importance:

Universal screening of patients with newly diagnosed cancer for hepatitis B virus (HBV), hepatitis C virus (HCV), and HIV is not routine in oncology practice, and experts disagree about whether universal screening should be performed.

Objective:

To estimate the prevalence of HBV, HCV, and HIV infection among persons with newly diagnosed cancer.

Design, Setting, and Participants:

Multicenter prospective cohort study of patients with newly diagnosed cancer (ie, identified within 120 days of cancer diagnosis) at 9 academic and 9 community oncology institutions affiliated with SWOG (formerly the Southwest Oncology Group) Cancer Research Network, a member of the National Clinical Trials Network, with enrollment from August 29, 2013, through February 15, 2017. The data analysis was conducted using data available through August 17, 2017.

Main Outcomes and Measures:

The accrual goal was 3000 patients and the primary end point was the presence of HBV infection (previous or chronic), HCV infection, or HIV infection at enrollment. Patients with previous knowledge of infection as well as patients with unknown viral viral status were evaluated.

Results:

Of 3092 registered patients, 3051 were eligible and evaluable. Median (range) age was 60.6 (18.2-93.7) years, 1842 (60.4%) were female, 553 (18.1%) were black, and 558 (18.3%) were Hispanic ethnicity. Screened patients had similar clinical and demographic characteristics compared with those registered. The observed infection rate for previous HBV infection was 6.5% (95% CI, 5.6%-7.4%; n = 197 of 3050 patients); chronic HBV, 0.6% (95% CI, 0.4%-1.0%; n = 19 of 3050 patients); HCV, 2.4% (95% CI, 1.9%-3.0%; n = 71 of 2990 patients); and HIV, 1.1% (95% CI, 0.8%-1.6%; n = 34 of 3045). Among those with viral infections, 8 patients with chronic HBV (42.1%; 95% CI, 20.3%-66.5%), 22 patients with HCV (31.0%; 95% CI, 20.5%-43.1%), and 2 patients with HIV (5.9%; 95% CI, 0.7%-19.7%) were newly diagnosed through the study. Among patients with infections, 4 patients with chronic HBV (21.1%; 95% CI, 6.1%-45.6%), 23 patients with HCV (32.4%; 95% CI, 21.8%-44.5%), and 7 patients with HIV (20.6%; 95% CI, 8.7%-37.9%) had no identifiable risk factors.

Conclusions and Relevance:

Results of this study found that a substantial proportion of patients with newly diagnosed cancer and concurrent HBV or HCV are unaware of their viral infection at the time of cancer diagnosis, and many had no identifiable risk factors for infection. Screening patients with cancer to identify HBV and HCV infection before starting treatment may be warranted to prevent viral reactivation and adverse clinical outcomes. The low rate of undiagnosed HIV infection may not support universal screening of newly diagnosed cancer patients.

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