Table 3.

Recommendations for management of HBV reactivation in patients receiving cancer chemotherapy.

1. HBsAg testing should be performed in patients who require cancer chemotherapy or a finite course of immunosuppressive agents.

2. Patients who require rituximab therapy or transplantation should be tested for HBsAg and anti-HBc.

3. Serum HBV DNA and ALT should be monitored every 1–3 months during and at least 6 months after completion of chemotherapy or immunosuppressive agents. Since HBV DNA precedes ALT, vigilance for HBV DNA is essential.

4. Prophylactic antiviral medication should be given to HBsAg positive patients before cancer chemotherapy or immunosuppressive agents.

5. Antiviral medication should be continued for 6 months after completion of cancer chemotherapy or immunosuppressive agents.

6. Chronic HBV patients with prechemotherapy serum HBV DNA of ≥2000 IU/ml should continue antiviral medication until:

a. HBeAg-positive patients: 6 months after HBeAg loss and anti-HBe detection.

b. HBeAg-negative patients: HBsAg clearance.

7. Antiviral medication should be given to HBsAg negative patients as soon as abrupt serum HBV DNA elevation is detected during cancer chemotherapy or immunosuppressive agents. Antiviral medication may be given to HBsAg-negative, anti-HBc-positive, anti-HBs-negative patients who receive rituximab.

8. The choice of antiviral medication can be based on the anticipated duration of treatment: lamivudine or telbivudine for duration of ≤12 months with undetectable serum HBV DNA and entecavir or tenofovir for longer duration or for patients with detectable HBV DNA prior to chemotherapy.

HBV, hepatitis B virus; HBsAg, hepatitis B surface antigen; HBeAg, hepatitis B extracellular antigen; ALT, alanine transaminase.