Long-term follow-up for incident cirrhosis among pediatric cancer survivors with hepatitis C virus infection

Abstract

Background Pediatric cancer patients who received blood transfusions were potentially exposed to hepatitis C virus (HCV) prior to second-generation HCV screening of blood products in 1992. Limited evidence is available about long-term incident cirrhosis in this population. Objectives We aimed to estimate the overall and sex-specific incidence of cirrhosis among HCV-seropositive survivors of pediatric cancer. Study design We identified 113 HCV-seropositive pediatric cancer patients treated at St. Jude Children’s Research Hospital between 1962 and 1997, who survived ≥5 years post-diagnosis, and were followed through 2014. Our outcome was cirrhosis determined by liver biopsy or diagnostic imaging. We used a competing-risk framework to estimate the overall and sex-specific cumulative incidence and 95% confidence limits (CL) of cirrhosis at 10-year follow-up intervals. Results The median duration of follow-up was 30 years (interquartile range=28 – 36) post-cancer diagnosis. Cumulative incidence of cirrhosis increased at each 10-year interval from 0% after 10 years to 13% after 40 years (Ptrend<0.001). The median age at diagnosis of cirrhosis was 30 years (interquartile range=24 – 38). We observed a linear trend in incidence for males (Ptrend<0.001), with a cumulative incidence of 18% (95% CL: 6.1%, 34%) after 40 years. The cumulative incidence for females was 6.5% (95% CL: 0.42%, 26%) after 40 years, but we did not observe a linear trend (Ptrend=0.99). Conclusion Our results suggest that the incidence of cirrhosis is similar between HCV-seropositive pediatric cancer survivors and the general population given similar duration of follow-up, but survivors may be diagnosed with cirrhosis at an earlier age.

Gastrointestinal and liver disease in Adult Life After Childhood Cancer in Scandinavia: A population‐based cohort study

“…recent study finds that HCV positive childhood cancer survivors develop cirrhosis at younger age than peers in the general population. 29 The most prominent finding in our study was the increased rate of intestinal diseases. The markedly high number of survivors admitted to hospital for constipation and paralytic ileus may be explained by treatment-related damage to the autonomous nervous system and subsequent dysmotility.…”

Chronic hepatitis C virus infection and neurocognitive function in adult survivors of childhood cancer

“…Our findings suggest that HCV-seropositive survivors of childhood cancer have a higher prevalence of neurocognitive impairment and reduced HRQOL in comparison with HCV-seronegative survivors, and both groups have been exposed to neurotoxic cancer therapies. In addition, our findings raise the awareness of a public health concern: adult survivors of childhood cancer, many of whom may be unaware of their exposure to blood products during the course of their cancer treatments, 41 may benefit from HCV screenings and education regarding the functional sequelae of HCV exposure.…”

Impact Analysis of the Hepatitis C Virus F Protein Deletion on Viral Replication and Pathogenic Infection

“…It is generally believed that the coding of the core protein and the sequence encoding the F protein overlap each other. The initiation site of the internal translation of the gene is thought to be codon 26 [8][9][10][11]. The coding position of the Core + 1 / S protein (the shortest F protein) is a gene of the core protein coding region (85-87), which is considered to be the starting point for the internal translation of the F protein [12].…”