Challenges in managing hepatitis C virus infection in cancer patients

Cancer patients have unique problems associated with hepatitis C virus(HCV)infection and treatment not seen in the general population.HCV infection poses additional challenges and considerations for the management of cancer,and vice versa.HCV infection also can lead to the development of cancer,particularly hepatocellular carcinoma and non-Hodgkin lymphoma.In severely immunocompromised cancer patients,diagnosis of HCV infection requires increased reliance on RNA detection techniques.HCV infection can affect chemotherapy,and delay of HCV infection treatment until completion of chemotherapy and achievement of cancer remission may be required to decrease the potential for drug-drug interactions between antineoplastic agents and HCV therapeutics and potentiation of side effects of these agents.In addition,hematopoietic stem cell transplant(HSCT)recipients have an increased risk of early development of cirrhosis and fibrosis.Whether this increased risk applies to all patients regardless of cancer treatment is unknown.Furthermore,patients with cancer may have poorer sustained virological responses to HCV infection treatment than do those without cancer.Unfortunately,not all cancer patients are candidates for HCV infection therapy.In this article,we review the challenges in managing HCV infection in cancer patients and HSCT recipients.

Coadministration of telaprevir and transcatheter arterial chemoembolization in hepatitis C virus-associated hepatocellular carcinoma

The use of directacting antiviral agents (e.g. , telaprevir, boceprevir) has improved response rates in patients with hepatitis C virus (HCV) genotype 1 infections. Substantial number of drug-drug interactions are anticipated with the use of telaprevir, a cytochrome P450 3A and P-glycoprotein substrate and inhibitor. Herein we describe a patient with HCV-associated hepatocellular carcinoma treated simultaneously with a telaprevir-containing regimen and localized chemo-therapy (transcatheter arterial chemoembolization) with doxorubicin. No clinically relevant interactions or adverse events developed while on antiviral therapy.

Challenge of hepatitis C in Egypt and hepatitis B in Mauritania

Egypt has one of the highest prevalence rates of hepatitis C virus(HCV) in the world,mostly with genotype 4 that is highly associated with severe fibrosis. As a consequence,hepatocellular carcinoma has become the leading cause of cancer in this country. Mauritania is a highly endemic area for hepatitis B virus(HBV). HBV and HCV could both be iatrogenically transmitted through infected blood products,infected needles,and medical equipment improperly sterilized. Adequate and efficient healthcare and public health measures with good surveillance programs,access for screening,prevention strategies,and successful treatment are needed to halt the spread of these diseases. Herein,we have reviewed the epidemiology,modes of transmission,predisposing factors,and novel treatment modalities of these viruses. We have proposed practices and interventions to decrease the risk of transmission of HCV and HBV in the affected countries,including strict adherence to standard precautions in the healthcare setting,rigorous education and training of patients and healthcare providers,universal screening of blood donors,use of safetyengineered devices,proper sterilization of medical equipment,hepatitis B vaccination,as well as effective direct-acting antiviral agents for the treatment of HCV.