The NCCN guidelines recommend CLL patients receive a hepatitis test to check for hepatitis B and hepatitis C antigens (fragments from the virus that trigger your immune system to detect the virus) and antibodies (proteins made by your immune system that attack the virus). The test is recommended because the hepatitis B virus can reactivate during treatment, and the hepatitis C virus could affect treatment results. 

What are the Hepatitis B and C Viruses? 

Hepatitis B (HBV) and hepatitis C (HCV) are viral infections that mainly affect the liver, leading to inflammation and potentially severe liver damage over time. HBV is transmitted through exposure to infected blood and bodily fluids, while HCV is mainly spread through direct contact with infected blood. Chronic infections can lead to liver complications. While a vaccine can prevent HBV, no vaccine is available for HCV. 

Patients may have a first exposure to HBV and HCV without any symptoms. These viruses can go silent. Carriers of HBV and HCV can experience the viruses reactivating. 

If HBV is reactivated, the antiviral entecavir is used to treat the infection. The medicine works by inhibiting the virus's ability to replicate, thereby reducing viral load and liver inflammation. Reactivated HCV treatment involves direct-acting antiviral agents, which target specific steps in the HCV life cycle, offering a high cure rate for the infection. Early detection and treatment of reactivated HBV or HCV help prevent liver complications. 

Why Can Hepatitis B Reactivate During CLL Treatment?

Hepatitis B may reactivate during CLL treatment because CLL medicines weaken the immune system. A weakened immune system is less capable of keeping latent HBV in check, potentially leading to the virus reactivating. 

How Can Hepatitis C Affect Treatment Results?

Hepatitis C affects the liver, often decreasing its ability to metabolize substances like medications. When CLL medicines cannot be broken down well by the liver, this reduces the effectiveness of treatment.  

Do I Need to Prepare for the Hepatitis Test?

Before the test, inform your healthcare provider of your hepatitis B vaccination status, past hepatitis infections, if you have experienced symptoms like jaundice or fatigue, medicine/supplement/drug use, family liver disease history, recent travel to areas with high hepatitis rates, and past blood transfusions or organ transplants. Answering these and possibly other questions from your healthcare provider helps review conditions that may affect test results.  

What are the Steps of the Hepatitis Test?

A healthcare professional will take a small sample of blood from a vein in your arm. The blood sample will be checked for several markers, including hepatitis B surface antigen (HBsAg), hepatitis B core antibody (anti-HBc), hepatitis B surface antibody (anti-HBs), and hepatitis C antibody (anti-HCV). These markers help determine whether an infection is present and if immunity has been acquired through vaccination or previous infection. 

What do My Hepatitis Test Results Mean?

You can expect your test results within a few business days. A positive result for HBsAg indicates an active HBV infection, which could be acute or chronic. The presence of anti-HBc suggests a past or ongoing infection, while anti-HBs indicate immunity to HBV. A positive result for anti-HCV means that you have been exposed to the hepatitis C virus, and further testing may be required to assess whether the infection is active. 

If there is an active hepatitis infection, an antiviral medication will be prescribed. This may be taken into account when adjusting your CLL medication, but in any case, it will delay the start of the cancer treatment. 

Conclusion

Before receiving CLL treatment, ask your doctor to conduct a hepatitis test. The test will help assess your risk level of hepatitis B reactivating or hepatitis C affecting your treatment results. 

Sources

• NCCN Guidelines for Patients: Chronic Lymphocytic Leukemia
• Hepatitis Panel
• CLL Supportive Care: Vaccines, Reactivated Viruses, & Infections
• Treatment Hepatitis C
• Risk of Hepatitis B Virus Reactivation in Chronic Lymphocytic Leukemia Patients
• Hepatitis B Virus and Hepatitis C Virus Reactivation in Cancer Patients Receiving Novel Anticancer Therapies
• How I treat Hepatitis C Virus Infection in Patients with Hematologic Malignancies
• Acute Viral Hepatitis Panel