Hepatitis B, C Linked to Non-Hodgkin Lymphoma in HIV Patients

HIV positive patients coinfected with hepatitis may face elevated cancer risk.

A recent study found an increased risk of non-Hodgkin lymphoma among patients with HIV and hepatitis B or hepatitis C virus.

These findings show that early diagnosis and treatment for HIV, as well as screening for hepatitis B virus and hepatitis C virus, is critical for preventing non-Hodgkin lymphoma in these patients, according to a study published in the Annals of Internal Medicine. Other studies have shown a link between hepatitis C virus and developing various forms of cancer, including lymphomas.

In the current study, 18 cohorts from the Collaboration of Observational HIV Epidemiological Research Europe were examined. Patients included were all HIV-positive and had information about hepatitis B virus antigen measurement and detectable hepatitis C virus RNA, or a positive antibody test, according to the study.

Overall, 52,479 treatment-naïve patients were included in the current study. Of these patients, 2.6% had hepatitis B virus, and 14.3% had hepatitis C virus. Approximately 0.4% of patients also had a duel infection.

A majority of patients started antiretroviral therapy, and they were followed for 50 months. Treatment-naïve patients were followed for 13 months. During the follow-up time, 252 treatment-naïve patients, and 310 treated patients developed non-Hodgkin lymphoma.

The hazard ratio for non-Hodgkin lymphoma with hepatitis B virus was 1.33 (95% CI, 0.69—2.56), and 0.67 (95% CI, 0.40–1.12) with hepatitis C virus. Specifically, for treatment-naive patients, the hazard ratio with hepatitis B virus was 1.74 (95% CI, 1.08–2.82) and 1.73 (95% CI, 1.21–2.46) with hepatitis C virus, the researchers reported.

Despite these findings, researchers said that the calculated risk in treatment-naïve patients was less certain, likely to do limited follow-ups, starting antiretroviral therapy, or other unmeasured factors. However, the findings may explain the increased risk of non-Hodgkin lymphoma during antiretroviral therapy for hepatitis B or C co-infection.

A majority of insurers have been prioritizing treatment for patients with late stage hepatitis because they say the drugs are too costly to treat all patients at once, which has created dialogue about the ethics of prioritizing the cure for some, while denying access to others.

Researchers said that HIV-positive patients with hepatitis should be granted high-priority access to interferon-free direct-acting antiviral treatment for their co-infection to prevent incidences of cancer, the study concluded.