Prevalence and Reactivation of Hepatitis B and C in Patients Undergoing Chemotherapy for Solid Tumors

Hepatitis B virus (HBV) and hepatitis C virus (HCV) infections are clinically significant in patients with cancer, as chemotherapy can trigger viral reactivation, leading to liver failure, treatment interruption, or death. Despite this risk, routine viral screening in patients with solid tumors remains inconsistent across institutions and guidelines. The purpose is to determine the frequency of viral screening and the prevalence of HBV, HCV, and HIV infections-and to assess the rate of viral reactivation-in a large cohort of newly diagnosed adult patients with cancer receiving chemotherapy.

A retrospective, multicenter cohort study was conducted across 15 oncology centers in Turkey. Data from 15,942 adults with solid tumors receiving parenteral chemotherapy between January 2018 and December 2022 were analyzed. Patients with primary liver cancer or those receiving non-immunosuppressive therapies were excluded.

Among 15,942 patients (median age, 58 years [range, 16-94]; 51.4% male), hepatitis B surface antigen (HBsAg) testing was performed in 90.3%, anti-HCV in 71.7%, and anti-HIV in 64.0%. HBV infection was identified in 4.5% (n = 645), with only 42.9% receiving antiviral prophylaxis. HBV reactivation occurred in 4.0% of HBsAg-positive patients (n = 26). Anti-HCV positivity was found in 0.4% (n = 46), of whom 17.4% had detectable HCV RNA and received treatment. HIV infection was rare (0.06%; n = 6), and no cases of viral reactivation were observed.

This large multicenter study highlights persistent gaps in viral screening and prophylaxis among patients with solid tumors. Despite lower HBV reactivation rates-likely due to partial prophylaxis-preventable complications still occurred. Despite increases in vaccination and prophylaxis, reactivation rates remain a significant problem. Standardized national protocols for prechemotherapy viral screening and timely antiviral therapy are essential to improve patient safety and treatment outcomes.