HCV reactivation can not worsen survival outcomes for lymphoma patients with HIV -
More than a quarter of HIV patients are also infected with the virus hepatitis C (HCV), which can complicate treatment and care decisions after a diagnosis of cancer. Details of these complications has been well documented in the past. The results of a new Fox Chase Cancer Center study of this patient population can begin to fill this gap
Fox Chase hematologist and medical oncologist Stefan K. Barta, MD, MS, MRCP -., Who led study - analyzed the HIV patient data + lymphoma diagnosis, collected over 17 years, to better understand how HCV infection influences survival results. Mr. Barta collaborators will present the group's findings at the 50th annual meeting of the American Society of Clinical Oncology.
Reactivation of HCV, in which the virus is detectable symptoms but not necessarily the origin, is common in HIV + patients. Notably, Dr. Barta and his team found that reactivation of hepatitis C does not seem worse survival outcomes for patients with lymphoma who also had HIV.
"Many patients do experience some reactivation of hepatitis C, but in most patients it seems to be self-limited and does not affect the results for the treatment of cancer" said Dr. Barta.
he noted that the treatment of patients co-infected with HIV lymphoma and HCV requires caution and care. HIV more than triple the risk of liver failure in people also infected with HCV, according to the Centers for Disease Control and Prevention. And among cancer patients, HIV patients infected with HCV can fall into a feedback loop that can decrease the effectiveness of treatment.
"patients undergoing chemotherapy may experience reactivation of herpes virus C, which in turn can lead to liver failure," said Dr. Barta. "This means that we have to reduce the dose of chemotherapy, which could adversely affect the results."
In addition, HIV patients often take a variety of other drugs, including antiretroviral drugs, which makes them particularly vulnerable to side effects such as toxicity. However, Dr. Barta said the new study suggests that the potential risks should not deter oncologists to treat these patients with chemotherapy.
"People should not be afraid to treat patients with HIV and HCV aggressive," said Dr. Barta. "At the same time, we must be careful to monitor these patients because reactivation occur and could potentially lead to severe liver failure."
He and his colleagues analyzed the medical records of 10 HIV patients who had been diagnosed with lymphoma at the Albert Einstein Cancer Center in the Bronx, New York, from 1997 to 2013. Patients with primary lymphoma central nervous system have been excluded. The researchers found that 53 patients, or 28 percent of eligible patients were also infected with HCV. The virus reactivated in 17 of these patients, about one third of the population of patients infected with HCV during treatment.
Patients infected with HCV were overall survival 59.7 months compared to 88.6 months for patients or HCV or hepatitis B (HBV). However, this survival advantage disappeared when the researchers adjusted for variables including age, sex, race, CD4 count, the presence of cirrhosis, type of lymphoma, and levels of lactate dehydrogenase (LDH , an enzyme). Multivariate analysis showed that co-infection with HCV was not associated with a lower overall survival in patients with lymphoma. At the same time, researchers have seen the overall survival results worse associated with low CD4 counts (below 100 cells / cubic millimeter), a diagnosis of non-Hodgkin lymphoma, the disease in an advanced stage, the levels LDH more than 10, or cirrhosis.
Dr. Barta said he hopes the new study opens clinical cancer trials to a little studied patient population. HIV patients with HCV are often excluded from clinical trials of cancer because of concerns about liver failure and drug toxicity, resulting from the interaction of retroviral drugs with chemotherapy. Barta said he hopes the new results suggest that these patients can tolerate chemotherapy without side effects, will help to reverse this trend.
"This is very important for a large proportion of patients," he said. "We want to assure researchers that these patients, as long as they have adequate liver function should also be enrolled in trials clinical. "
The co-authors Dr. Barta include Ashwin Sridharan, Santiago Aparo, Susanna A. Curtis and Justin D. Kaner.
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