The effect of transcatheter arterial chemoembolization on hepatitis C virus (HCV) kinetics in patients with HCV-associated hepatocellular carcinoma.

Abstract

e14578 Background: Reactivation of chronic HCV infection due to systemic chemotherapy has been sporadically reported. Transcatheter arterial chemoembolization (TACE) is an important treatment modality for unresectable hepatocellular carcinoma (HCC). A previous prospective study has suggested that TACE does not aggravate hepatitis B virus infection. We retrospectively evaluated the effect of TACE on HCV kinetics and liver function in patients with HCV associated HCC. Methods: Medical records of HCV associated HCC cases seen at our institution between 01/01/2008 and 12/31/2009 were identified. Clinical and virological data were analyzed. Reactivation of HCV was defined as a > 2 log IU/mL increase in post TACE HCV RNA as compared to baseline (pre TACE) levels. Acute exacerbation of hepatitis (AcEx) was defined as a > 3-fold increase in serum alanine aminotransferase (ALT) level, in the absence of other hepatotoxic drugs, systemic infections and recent blood transfusions. Results: Out of the 84 HCV associated HCC cases identified, 24 (29%) received TACE. Three of them had pre and post TACE HCV RNA levels. TACE was conducted with cisplatin, mitomycin and doxorubicin in two patients, and only doxorubicin in one patient. They received a total of six TACE procedures. Six episodes of AcEx were noted, one after every TACE procedure, with a median ALT peak of 394 (range, 191-2,295) IU/mL at an average of 2.7 (range, 2-3) days after TACE. Viral loads were measured on an average of 80 (range, 50-125) days after TACE. Increase in the HCV RNA levels was observed in two patients, average 0.26 (0.14-0.38) log IU/mL. In the third patient, HCV RNA after TACE decreased by 0.20 log IU/ml. No cases of HCV reactivation were identified. Two cases had genotype 1a and one had genotype 2b. All three cases were naïve to HCV therapy. Conclusions: Even though we cannot rule out a transient reactivation of HCV following TACE, increase in HCV activity appears to be uncommon following this procedure. However, larger prospective series are warranted to better define this entity.