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World J Gastroenterol. Aug 21, 2021; 27(31): 5181-5188
Published online Aug 21, 2021. doi: 10.3748/wjg.v27.i31.5181
Screening and prevention of hepatitis C virus reactivation during chemotherapy
Yuan-Rung Li, Tsung-Hui Hu, Wen-Chi Chen, Ping-I Hsu, Hui-Chun Chen
Yuan-Rung Li, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung 813, Taiwan
Tsung-Hui Hu, Department of Internal Medicine, Chang Gung University College of Medicine, Kaohsiung 833, Taiwan
Wen-Chi Chen, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung 813, Taiwan
Ping-I Hsu, Division of Gastroenterology and Hepatology, Department of Internal Medicine, An Nan Hospital, China Medical University, Tainan 709, Taiwan
Hui-Chun Chen, Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan
Author contributions: Li YR developed the theory and performed the computations; Chen WC and Hsu PI verified the analytical methods; Hu TH, Chen HC and Hsu PI supervised the findings of this work; all authors discussed the results and contributed to the final manuscript.
Conflict-of-interest statement: All authors have and declare that there are no other relationships or activities that could appear to have influenced the submitted work.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ping-I Hsu, PhD, Professor, Division of Gastroenterology and Hepatology, Department of Internal Medicine, An Nan Hospital, China Medical University, No. 66, Sec. 2, Changhe Rd, Tainan 709, Taiwan. williamhsup@yahoo.com.tw
Received: January 28, 2021
Peer-review started: January 28, 2021
First decision: May 2, 2021
Revised: May 23, 2021
Accepted: August 2, 2021
Article in press: August 2, 2021
Published online: August 21, 2021
Abstract

Hepatitis C virus (HCV) reactivation occurs in 23% of HCV-infected cancer patients receiving chemotherapy. Forty-three percent of the patients with reactivation of HCV during chemotherapy develop a hepatitis flare. Most of the cancer patients with HCV reactivation have an unremarkable clinical course following an HCV-related hepatitis flare during chemotherapy. However, 26%–57% of the cancer patients developing an acute flare of chronic hepatitis C during chemotherapy require unanticipated discontinuation or dose reduction of chemotherapy, which results in deleterious changes in the cancer treatment plan. Although an optimal strategy for HCV screening in cancer patients receiving chemotherapy has not been established, universal pre-chemotherapy HCV testing for patients with hematological malignancies is recommended by current guidelines. All the currently approved direct-acting antivirals (DAAs) can be used in cancer patients, but the use of DAAs during chemotherapy should avoid drug–drug interactions between chemotherapy and antiviral agents. If there are no contraindications or anticipated drug–drug interactions, DAAs treatment can be administered before, during, or after chemotherapy. In conclusion, HCV reactivation occurs in approximately one-fourth of HCV-infected cancer patients receiving chemotherapy. An HCV-related hepatitis flare during chemotherapy may lead to the discontinuation of potentially life-saving chemotherapy. Currently, universal HCV screening is recommended in hematological malignancy patients before chemotherapy, but there is no evidence-based guideline for other cancer patients. DAAs treatment can cure HCV infection and prevent HCV reactivation during chemotherapy.

Keywords: Hepatitis C virus, Chemotherapy, Screening, Reactivation, Hepatitis flare

Core Tip: Hepatitis C virus (HCV) reactivation occurs in approximately one-fourth of HCV-infected cancer patients receiving chemotherapy. An HCV-related hepatitis flare during chemotherapy may lead to the discontinuation of potentially life-saving chemotherapy. Currently, universal HCV screening is recommended in hematological malignancy patients before chemotherapy, but there is no evidence-based guideline for other cancer patients. direct-acting antivirals treatment can cure HCV infection and prevent HCV reactivation during chemotherapy.