Occult hepatitis B and occult hepatitis C viremia in patients with hematologic malignancies.

Abstract

e17016 Background: Occult Hepatitis B (OHB)and Hepatitis C (OHC) in patients with hematological malignancies (HM) are understudied, mainly because biopsies to identify these viruses in the liver are often not performed due to an associated risk of complications (e.g., bleeding). We describe our retrospective experience of patients with HM tested for OHB and OHC. Methods: Between 09/09 and 11/10, 18 unselected consecutive patients with an abnormal liver panel were tested for both OHB and OHC which was defined as detectable viremia in the absence of HBsAg and anti-HCV, respectively. Severe liver dysfunction was defined as ALT >10 times the upper limit of normal (>560 IU/L) and/or a total bilirubin >6 mg/dL. Plasma samples were tested for HBV DNA and HCV RNA by using real-time PCR (Cobas Taqman HBV and HCV Tests-Roche Molecular Systems). Results: Most patients (12 or 67%) had leukemia, followed by lymphoma (5 patients or 28%). Two patients (11%) had OHB, and none had OHC.The 2 patients with OHB were born in areas with an intermediate to high prevalence of HBV; both had only low grade viremia (<29 IU/mL). At the time HBV DNA testing was performed, peak ALT levels in these 2 patients were 843 IU/L and 6,047 IU/L compared to a median peak ALT of 302 IU/L (range, 84-1,320 IU/L) among those without OHB (P=0.03). Severe liver dysfunction occurred in the 2 (100%) patients with OHB compared to 6 (38%) of the non-OHB cases (P=0.1). Durations of ALT elevation were 12 and 17 days in patients with OHB, compared to a median duration of 13 days (range, 5-73 days) in non-OHB patients. Co-infections were identified in 1 patient with OHB and in 10 (63%) without OHB. The 2 patients with OHB and 8 (50%) patients without OHB died within 6 months after HBV DNA testing. Conclusions: Although our data are limited, in a group of cancer patients in whom a liver biopsy is not available, detection of HBV DNA or HCV RNA in serum in the absence of HBsAg or anti-HCV identifies a subset of patients with occult viral hepatitis, a phenomenon of unclear clinical significance.