Determination of screening frequency and prevalences for hepatitis B virus hepatitis C virus HIV infection in adult patients with solid organ tumor

Aim: Hepatitis B virus, Hepatitis C virus and HIV infection, continue to be an important public health problem, all over the world, despite the improvement in diagnosis and treatment methods. Our country is located in the middle endemic region in terms of HBV and HBsAg positivity is observed in a substantial part of the population. These infections are also encountered in patients with solid organ tumors. Reactivation can be seen during or after immunosuppressive therapy in patients followed up for malignancy and exposed to HBV and HCV. In particular, HBV reactivation is of great importance as it can result in morbidity and mortality. Screening patients for these infections prior to treatment is key to preventing reactivation. In the studies, it is seen that sufficient importance is not given to pre-treatment screening. In our study, we aimed to determine the incidence of HBV, HCV, HIV and pre-treatment screening rates in patients who were followed up and treated for solid organ tumors in our center and to raise awareness about this issue. Material and Method: Patients over the age of 18, who were followed up and treated for solid organ tumors in Dokuz Eylul University, Faculty of Medicine, Department of Internal Diseases, Department of Medical Oncology between 01.01.2016 and 01.01.2022 were included in our study. The age, gender, histopathological diagnosis, treatment agents, antiviral prophylaxis administration and serological parameters of the patients were retrospectively scanned and recorded. In patients treated with immunosuppressive therapy, pre-treatment HbsAg, Anti-HBs and Anti-HBc IgG together was considered as appropriate screening for HBV. In terms of HBV reactivation, patients were divided into risk groups according to their serology status and the agents used in the treatment, and antiviral prophylaxis application rates suitable for risk groups were investigated. Findings: In our study, it was observed that 13.7% of the patients were requested HbsAg, 13.3% Anti-HCV, 11.8% Anti-HBs and 10.5% Anti-Hbc IgG. In the patient group for which the relevant tests were requested, HbsAg positivity was 3.3%, Anti-HCV positivity was 1%, Anti-HBs positivity was 35.5%, Anti-HBc IgG positivity was 35.5%, and isolated Anti-HBc IgG positivity was 6.2%. In 137 patients with isolated Anti-HBc IgG positivity, it was observed that HBV-DNA was not requested before treatment. It was observed that the appropriate screening rate for HBV was 69.8% in patients treated for malignancy. As a result of this data, it was determined that 30.2% of the treated patients were not screened appropriately. When the distribution of the patients who had appropriate screening was examined according to the years, it was determined that 77.6% of the patients belonged to the last three years. As a result of the screening, antiviral prophylaxis was applied to 13 (76.5%) of the patients who were risk-classified and evaluated as high-risk, while it was not applied to four (23.5%). It was determined that prophylaxis was applied to 59 (67.8%) of the moderate-risk patients, while 28 (32.3%) were not applied. It was determined that antiviral prophylaxis was applied to 151 (46.4%) of the patients evaluated as low risk, and 172 (53.6%) were not applied. Results: When the data in our study are evaluated, it is seen that the frequency of HBV, HCV and HIV serological parameters in patients with solid organ tumors and the appropriate screening rates for HBV in patients who are planned for immunosuppressive treatment are not sufficient. Incorrect antiviral prophylaxis practices were found in patients who were screened appropriately. We think that it is very important to increase awareness on this issue in order to protect patients from HBV and HCV reactivation. For this reason, approaches such as organizing regular training meetings in the current guidelines of the associations interested in the subject, where screening and antiviral prophylaxis application recommendations are explained, and integrating a warning message to the hospital automation system for HBV and HCV screening before immunosuppressive treatment, increase the rates of appropriate screening and antiviral prophylaxis application. We think it will. Keywords: Solid organ tumors, Hepatitis B, Hepatitis C, Screenig, Reactivation