a Department of Clinical Science, Intervention and Technology (CLINTEC) , Karolinska Institutet , Stockholm , Sweden.
b Department of Pediatrics , Karolinska University Hospital , Stockholm , Sweden.
Acta Oncol. 2019 Jul;58(7):997-1002. doi: 10.1080/0284186X.2019.1574105. Epub 2019 Feb 14.
Childhood cancer survivors treated before 1992, when blood donor screening for hepatitis C virus (HCV) infection was introduced, are at risk of transfusion-transmitted HCV infection. A national HCV screening campaign targeting blood transfusion recipients was launched in Sweden in 2007-2010. The aims of this study were to, among adult childhood cancer survivors in Stockholm County, investigate the prevalence of HCV infection, the natural course of infection, treatment outcome and anti-HCV testing frequency before, during and after the screening campaign and finally to actively screen the untested ones. This was a combined retrospective register based and prospective screening study of adult childhood cancer survivors ( = 686) treated for malignancy in Stockholm before 1992. In the first part, we investigated the prevalence of HCV infection and previous anti-HCV testing, and in the second part, we actively traced and HCV-screened the remaining untested cohort living in Stockholm. Analysis of previous documented anti-HCV tests in medical records, laboratory records, and the national communicable disease registry was performed. In the second part, 231 presumably untested individuals were contacted by mail and offered an anti-HCV test. The natural course of HCV infection and treatment outcome was analyzed for those found to be chronically infected. In total, 235 patients were tested and 11 were HCV-RNA positive. The overall prevalence of chronic HCV infection among the tested childhood cancer survivors was thus 4.7% (95% CI = 2.6-8.2%), which is almost 10 times higher than the national prevalence of 0.5%. Only 12% of the Stockholm cohort were tested during the screening campaign in 2007-2010, while the test uptake using active tracing screening within this study was 40% ( < .001). With today's effective treatment options, active tracing and HCV screening of childhood cancer survivors are recommended.
1992 年以前接受治疗的儿童癌症幸存者在接受输血治疗时面临丙型肝炎病毒（HCV）感染的风险，因为那时的血液供体筛查尚未引入。2007 年至 2010 年，瑞典在全国范围内针对输血接受者开展了 HCV 筛查活动。本研究的目的是，在斯德哥尔摩县的成年儿童癌症幸存者中，调查 HCV 感染的流行率、感染的自然病程、治疗结果以及在筛查活动之前、期间和之后的抗 HCV 检测频率，最后主动筛查未检测的患者。这是一项针对斯德哥尔摩县 1992 年前接受恶性肿瘤治疗的成年儿童癌症幸存者（ = 686）的回顾性基于登记和前瞻性筛查研究。在第一部分中，我们调查了 HCV 感染和之前抗 HCV 检测的流行率，在第二部分中，我们主动追踪和 HCV 筛查居住在斯德哥尔摩的其余未检测队列。对病历、实验室记录和国家传染病登记处记录的先前记录的抗 HCV 检测进行了分析。在第二部分中，通过邮件联系了 231 名可能未接受检测的人，并为他们提供了 HCV 检测。对被发现慢性感染的人进行了 HCV 感染自然病程和治疗结果的分析。共有 235 名患者接受了检测，11 名 HCV-RNA 阳性。因此，接受检测的儿童癌症幸存者中慢性 HCV 感染的总患病率为 4.7%（95%CI=2.6-8.2%），几乎是全国 0.5%流行率的 10 倍。在 2007 年至 2010 年的筛查活动中，只有 12%的斯德哥尔摩队列接受了检测，而在本研究中通过主动追踪筛查的检测率为 40%（ < .001）。鉴于目前有效的治疗选择，建议对儿童癌症幸存者进行主动追踪和 HCV 筛查。
