Blood, Vol. 94 No. 12 (December 15), 1999:
pp. 4046-4052
Dual or Single Hepatitis B and C Virus Infections in Childhood Cancer
Survivors: Long-Term Follow-Up and Effect of Interferon Treatment
Riccardo Utili,
Rosa Zampino,
Pasquale Bellopede,
Marta Marracino,
Enrico Ragone,
Luigi Elio Adinolfi,
Giuseppe Ruggiero,
Maria Capasso,
Paolo Indolfi,
Fiorina Casale,
Adele Martini, and
Maria Teresa Di
Tullio
From the Institute of Medical Therapy, Chair of Infectious Diseases,
Pediatric Oncologic Service, 2nd University of Naples,
Medical School, Naples, Italy.
We conducted a long-term prospective study of 89 cancer survivor
children who had acquired hepatitis B virus (HBV) and/or hepatitis C
virus (HCV) during treatment for neoplasia, the aim being to evaluate
the natural history of 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 infected by HBV, 11 by HCV, and 32 coinfected
by HBV and HCV. A spontaneous clearance of hepatitis B surface antigen
(HBsAg) occurred more frequently in coinfected patients
(19%) than in the HBV-infected (2%; P = .004), with an
annual 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 HBV-infected patients. Clearance of serum
HCV-RNA was observed in 34% and 9%, respectively, of coinfected and
HCV-infected patients. Seventeen HBV-infected, 4 HCV-infected, and 16 coinfected patients received 
-IFN treatment. In the HBV group,
6 patients (35%) cleared serum HBV DNA and seroconverted to anti-HBe;
in the HCV-group, none cleared HCV-RNA. In the coinfected group, 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 coinfected patients. Treatment seems to be effective
for selected cases and is justified in view of the uncertain prognosis
of the disease in these patients.
