Screening and prevention of hepatitis C virus reactivation during chemotherapy

Table 1 Recommended definitions of quiescent hepatitis C virus infection, hepatitis C virus reactivation and hepatitis C virus-related hepatitis flare in cancer patients receiving chemotherapy

Term	Definition	Ref.
Quiescent HCV infection	An HCV infection with a positive serum HCV-RNA and normal serum levels of liver enzymes	IARC Monographs on the Evaluation of Carcinogenic Risks to Humans, No. 59[30]
HCV reactivation	Increase in HCV-RNA level during chemotherapy of ≥ 1 log10 IU/mL over baseline	Talima et al[17]
HCV-related hepatitis flare	Unexplained increase in ALT to 3 times the upper limit of normal during chemotherapy and increase in HCV-RNA level of ≥ 1 log10 IU/mL over baseline	Torres et al[18]

IARC: International Agency for Research on Cancer; HCV: Hepatitis C virus.

Table 2 Incidence of hepatitis C virus-related hepatitis flare in cancer patients receiving chemotherapy

Ref.	Study type	Cancer type	Results
Torres et al[18]	Prospective observation study	Hematological tumor (n = 50)	A hepatitis flare occurred in 10% of HCV-infected cancer patients receiving chemotherapy
		Non-HCC solid tumor (n = 50)	Definition of HCV-related hepatitis flare: unexplained increase in ALT to 3 times the upper limit of normal and increase in HCV-RNA level of ≥ 1 log10 IU/mL over baseline
Li et al[4]	Retrospective observation study	Hematological tumor (n = 569); HCC (n = 256); Non-HCC solid tumor (n = 3900)	The incidence of severe acute liver injury in HCV-infected hematological cancer patients was higher than that in those with HCC patients and non-HCC solid tumor patients (9.4% vs 1.9 % and 1.1%, respectively). Definition of severe acute liver injury: ALT increased beyond 10 times the upper limit of normal during chemotherapy or 6 months following chemotherapy
Tomizawa et al[28]	Retrospective observation study	Colorectal cancer (n = 24)	The incidence of severe acute exacerbation rate in HCV-infected patients was 8%. Definition of severe acute exacerbation: ALT increased beyond 5 times the upper limit of normal
Hsu et al[22]	Retrospective observation study	Hematological tumor (n = 104); Solid tumor (n = 204)	The incidence of HCV acute exacerbation was 11% (hematological tumor: 23%; solid tumor: 4.4%). Definition of HCV acute exacerbation: 3-fold or greater increase in serum ALT level

HCV: Hepatitis C virus; HCC: Hepatocellular carcinoma; ALT: Alanine aminotransferase.

Table 3 Clinical outcomes of hepatitis C virus-related hepatitis flare during chemotherapy

Ref.	Study type	Cancer type	Liver decompensation	Interruption of chemotherapy	Mortality due to HCV reactivation
Torres et al[18]	Prospective observation study	Hematological tumor (n = 18)	Total: 0%	Total: 26%	Total: 0%
		Solid tumor (n = 5)
Fujii et al[6]	Prospective study	Leukemia (n = 21)	Total: 28.6%	—	—
Li et al[4]	Retrospective observation study	Hematological tumor (n = 3)	Total: 0%	Total: 57%	Total: 0%
			(Hematological tumor: 0%;	(Hematological tumor: 67%;	(Hematological tumor: 0%;
		HCC (n = 2)	HCC: 0%;	HCC: 50%;	HCC: 0%;
		Non-HCC solid tumor (n = 2)	Non-HCC solid tumor: 0%)	solid tumor: 50%)	Non-HCC solid tumor: 0%)
Lee et al[16]	Retrospective study	Hematological tumor (n = 14)	Total: 0%	Total: 32%	Total: 0%
		Solid tumor (n = 11)
Mahale et al[5]	Retrospective study	Hematological tumor (n = 24)	Total: 0%	Total: 45%	Total: 0%
		Solid tumor (n = 9)
Zuckerman et al[7]	Retrospective study	Hematological tumor (n = 33)	Total: 0%	—	Total: 0%

HCV: Hepatitis C virus; HCC: Hepatocellular carcinoma.