Epidemiology

HCV infection associated with development of non-Hodgkin lymphoma

Last Updated: 2007-05-08 19:48:14 -0400 (Reuters Health)

NEW YORK (Reuters Health) - The prevalence of non-Hodgkin lymphoma and other lymphoproliferative diseases is increased in patients infected with hepatitis C virus (HCV), investigators report in the Journal of the American Medical Association for May 9.

To provide sufficient power to uncover links between HCV and non-hepatic disorders, a research team based at the Michael E. DeBakey Veterans Affairs (VA) Medical Center in Houston and at the National Cancer Institute in Rockville, Maryland, used data compiled from VA administrative records. They were interested in VA records because the prevalence of HCV is nearly three times higher among veterans than in the general population.

The VA's Dr. Thomas P Giordano and colleagues searched for associations with leukemias and other types of lymphomas, including Waldenstrom macroglobulinemia, among 146,000 HCV-infected patients and 572,000 uninfected control subjects. Mean follow-up was 2.3 years.

They found an increased risk for non-Hodgkin lymphoma (adjusted hazard ratio = 1.28) and for Waldenstrom macroglobulinemia (HR = 2.76) associated with HCV infection. Risk was also higher for cryoglobulinemia (HR = 3.98) and thyroiditis (HR = 1.13). The p value for all four conditions was < 0.0038.

The risk was also increased for monoclonal gammopathy of undetermined significance (MGUS), but the difference was not significant after adjustment for co-factors (HR = 1.28, p = 0.06).

"We demonstrated that (HCV) infection precedes development of these outcomes," Dr. Giordano and colleagues write. They suggest "the intriguing possibility that chronic immune stimulation by HCV infection can result in progression along a spectrum of IgM monoclonal gammopathy from asymptomatic MGUS to symptomatic cryoglobulinemia to the malignant Waldenstrom macroglobulinemia."

JAMA 2007;297:2010-2017.