Role of screening for hepatitis C virus in children with malignant disease and who undergo bone marrow transplantation

BACKGROUND: Children with malignant disease who received multiple blood transfusions before the clinical definition of hepatitis C virus (HCV) require evaluation for HCV infection. STUDY DESIGN AND METHODS: The role of HCV infection in 54 children with primary malignant disease was evaluated in terms of the following aspects: prevalence of HCV infection, distribution of HCV subtype, the benefit of screening of blood donors, and the presence of chronic liver disease. The benefit of screening for HCV in a subset of patients who underwent bone marrow transplantation (BMT) was also evaluated. RESULTS: Seventeen patients (31.4%) of 54 tested were seropositive in a second‐generation HCV antibody test. Thirteen patients (24.0%) were also positive for circulating HCV RNA. HCV subtype 1b and HCV subtype 2b were found in six and two patients, respectively. Multiple HCV genotypes were present in two patients. One of these two patients had relatively progressive liver disease. Before the introduction of blood screening with a second‐ generation HCV antibody test, 15 of 35 patients seroconverted, whereas none of 7 patients seroconverted after the screening was used (p = 0.032). For patients who underwent BMT, the screening drastically decreased the seroconversion rate, from 7 of 11 patients to 0 of 6 (p = 0.016). CONCLUSION: A considerable number of children with primary malignant disease who received multiple blood transfusions became infected by HCV before HCV screening was used. Patients who underwent BMT were at high risk for HCV infection. Screening with a second‐ generation HCV antibody test has proven to be remarkably beneficial in preventing HCV infection in these children.