Blood, Vol. 95 No. 11 (June 1), 2000:
pp. 3640-3641
CORRESPONDENCE
 |
To the Editor: |
Hepatitis C virus infection in patients with non-Hodgkin lymphoma
in Thailand
The role of hepatitis C virus (HCV) in the pathogenesis of
non-Hodgkin lymphoma (NHL) is controversial.1-3 Germanidis
et al4 recently reported in Blood the lack of
association of HCV infection and NHL in France, where HCV infection is
not common. This is in contrast to the reported high prevalence of HCV
infection in patients with NHL (9% to 35%) in Italy5 and
North America,6 where HCV infection in normal population is
quite frequent (1% to 5%). These results lead to speculation that
HCV infection may be associated with NHL only in areas where HCV is
highly prevalent.
Thailand has had an increasing incidence of NHL in recent
years.7 It also has a high prevalence of HCV infection,
averaging 1% to 5% in the general
population.8-9 The aim of our study was therefore to
determine whether high prevalence of HCV infection exists in our Thai
patients with NHL. Ninety-eight patients with intermediate- to
high-grade NHL and 32 patients with low-grade NHL seen at Siriraj
Hospital were screened for HCV using Cobas Core anti-HCV indirect EIA
assay (Roche, Basel, Switzerland) after informed consent. NHL was
classified according to working formulation. The
Table shows the prevalence of anti-HCV
antibody according to NHL subtype.
The overall prevalence of HCV
antibody in Thai NHL patients was 2.3%. All patients were HIV-negative
and not previously transfused. Only 3 out of 130 cases were
HCV-positive including 2 patients with diffuse large-cell lymphoma and
1 patient with follicular mixed small- and large-cell lymphoma. The
route of HCV infection in the first 2 patients with intermediate-grade
NHL was not clear because no history of blood transfusion or drug abuse
could be elicited. The route of viral acquisition in the third patient with low-grade NHL, however, is quite unique because he developed hepatitis after a cut injury occurred while he was performing a
surgical procedure in North America. He received interferon treatment
for hepatitis and subsequently cleared the virus several years prior to
the diagnosis of NHL. PCR for 8 HCV genotypes did not reveal HCV RNA
at the time of diagnosis of NHL in Thailand. Whether HCV
infection led to the development of NHL in this third patient is
unknown. Our overall results, however, do not support the existence of
a significant relationship between HCV infection and NHL in Thailand.
NHL in Thailand has a different distribution of histologic subtypes
than does the West, with a lower prevalence of low-grade B-cell NHL
(averaging 10%).7,10 Whether this may account for the
overall low prevalence of HCV infection in NHL in our country is not known. Source and genotype of HCV may play an important role.
The predominant HCV genotypes in Thailand appeared to be different from
those found in the West.11-12
In conclusion, although HCV infection is common in Thailand,
the majority of Thai NHL patients do not carry the HCV antibody. HCV
infection is unlikely to play a major role in the pathogenesis of NHL
in Thailand, where HCV infection is highly prevalent.
Chirayu Udomsakdi-Auewarakul
Prasert Auewarakul
Sanya Sukpanichnant
Wanna Muangsup
Faculty of Medicine
Siriraj Hospital
Mahidol
University
Bangkok, Thailand
| |
References |
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