Table 1.

Strategies for Testing and Management of HBV During Immunosuppressive Therapy

Test	Population to Be Screened	Significance of Positive Result	Action
HBsAg	All patients scheduled to receive immunosuppressive therapy	HBV infection	Antiviral prophylaxis indicated
Anti‐HBs alone	None	Immunity to HBV	None
Anti‐HBc± anti‐HBs	All patients scheduled to receive myeloablative, rituximab, or TNF inhibitor–containing therapy	Exposure to HBV infection	If HBsAg‐positive: as above
			If HBsAg‐negative: low risk for standard chemotherapy
			If BMT/rituximab/anti‐TNF: monitoring essential; consider antiviral prophylaxis
HBV DNA	All HBsAg‐positive and anti‐HBc–positive patients	1. Undetectable	1. Lamivudine adequate
		2. <2,000 IU/mL	2. Lamivudine adequate
		3. ≥2,000 IU/mL	3. Consider agent with higher barrier to resistance