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Hepatitis C virus infection in children treated for acute lymphoblastic
leukemia
M Arico, G Maggiore, E Silini, F Bono, C Vigano, A Cerino and MU Mondelli
Dipartimento di Patologia Umana, Universita di Pavia, Italy.
We studied 102 consecutive subjects after their completion of acute
lymphoblastic leukemia (ALL)-directed chemotherapy, for evidence of
hepatitis C virus (HCV) infection by enzyme immunoassay 2 and 3, second
generation recombinant immunoblot assay and reverse transcription-
polymerase chain reaction (PCR) for detection of circulating HCV-RNA.
Forty-four patients (43%) had evidence of exposure to HCV; 30 of these were
anti-HCV+. Of the 23 patients who were positive for both anti-HCV and
HCV-RNA, 16 (69%) had a moderate increase in serum alanine aminotransferase
(ALT) activity without clinical signs of liver disease. Fourteen patients
were seronegative despite the presence of HCV-RNA in the serum. The
proportion of different HCV genotypes was not significantly different from
other anti-HCV+ patient groups. Although half of the patients with genotype
III had normal ALT value, patients with normal ALT levels were represented
in all genotype groups. Our study documents the prevalence of HCV infection
in childhood ALL survivors, which is responsible for the majority of cases
of non-B chronic liver disease in these patients. Whereas serologic
screening identifies over 70% of patients with ongoing HCV infection, real
HCV infection may be present even in the absence of a detectable humoral
immune response to the virus. Based on this observation, determination of
HCV-RNA by PCR should be recommended in patients in prolonged remission
even if they test negative on serological assay. Normal ALT levels do not
exclude the presence of HCV infection because the values were repeatedly
normal in over half of our viremic patients.
Volume 84,
Issue 9,
pp. 2919-2922,
11/01/1994
Copyright © 1994 by The American Society of Hematology
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