Table 1.
Selected Guidance Documents With Recommendations for Hepatitis B Screening
| Recommending Body | Patient Population | Screening Recommendation | Serologic Tests | Prophylaxis |
|---|---|---|---|---|
| American Association for the Study of Liver Diseases (2009)10 | Patients receiving cytotoxic or immunosuppressive therapy | Screen patients at high risk for HBV infection | HBsAg, anti-HBc | Lamivudine, telbivudine, tenofovir, or entecavir for all HBV carriers; continue for ≥ 6 months after oncologic therapy |
| Centers for Disease Control and Prevention (2009)11 | Patients receiving cytotoxic or immunosuppressive therapy | Screen all | HBsAg, anti-HBc, anti-HBs | Prophylactic antiviral therapy for HBsAg-positive patients |
| British Committee for Standards in Haematology (2012)12 | Patients with follicular lymphoma | Test for HBV should be undertaken (according to local protocol developed in conjunction with virologist) at baseline and in all patients considered at risk of virus reactivation for whom immunotherapy is treatment of choice | Not specified | Not specified |
| European Society for Medical Oncology (2014)13 | Patients with follicular lymphoma | Screen all | Not specified | In patients with positive hepatitis B serology, prophylactic antiviral medication is strongly recommended |
| National Comprehensive Cancer Network Non-Hodgkin's Lymphoma (2014)14 | Patients with non-Hodgkin lymphoma | Screen all receiving anti-CD20 antibody therapy; in areas of high or unknown HBV prevalence, test all patients receiving immunotherapy, chemotherapy, or chemoimmunotherapy | HBsAg, anti-HBc; add e-antigen if risk factors or history of HBV; if positive, check viral load and consult with gastroenterologist | Prophylactic antiviral therapy with entecavir for HBsAg-positive patients; monitor viral load with PCR monthly during treatment and every 3 months after treatment; avoid lamivudine because of resistance |
| National Comprehensive Cancer Network Cancer-Related Infections (2014)15 | All patients with cancer | Screen patients at high risk of HBV infection; universal screening for HBV if risk-based screening is not done | HBsAg, anti-HBc | Antiviral therapy with adefovir, entecavir, lamivudine, telbivudine, or tenofovir |
| American Gastroenterological Association Institute (2015)16 | Patients who will be treated with immunosuppressive therapy | Screen patients at high risk for HBV infection or moderate or high risk of HBV reactivation | HBsAg, anti-HBc | Antiviral prophylaxis in high- and moderate-risk patients; recommend against routine antiviral prophylaxis in low-risk patients; antivirals with high barrier to resistance recommended over lamivudine; treatment should be continued for 6 months after discontinuation of immunosuppressive therapy |
| American Society of Clinical Oncology (2015) | Patients receiving immunosuppressive therapy | Screen patients who have risk factors for HBV infection or for whom immunosuppressive therapy associated with HBV reactivation is planned | HBsAg, anti-HBc | Antiviral therapy with evidence of chronic HBV infection |
NOTE. Data adapted with permission.17
Abbreviations: anti-HBc, antibody to hepatitis B core antigen; anti-HBs, antibody to hepatitis B surface antigen; HBsAg, hepatitis B surface antigen; HBV, hepatitis B virus; PCR, polymerase chain reaction.