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. 2021 Apr 2;11(4):267. doi: 10.3390/jpm11040267

Table 4.

Guidelines on screening and management for HBV reactivation before immunosuppression therapy.

Society Who Should Be Screened? Screening Tests Strategy Choice of NAs NAs Duration Monitoring after Prophylaxis
American Association for the Study of Liver Diseases (AASLD) 2018 guideline [2] All patients HBsAg and anti-HBcAb

  • HBsAg (+): prophylaxis

  • Resolved HBV: on- demend therapy except for patients receiving anti-CD20 antibody therapy or stem cell transplantation (monitor ALT, HBV DNA, HBsAg every 1–3 months)

 ETV, TDF, TAF

  • At least 6 months after discontinuation of immunosuppressive therapy

  • At least 12 months for B cell–depleting agents

 Patients should be monitored for up to 12 months after cessation of anti-HBV therapy
American Gastroenterological Association (AGA) 2015 guideline [25] Moderate or high risk of HBV reactivation HBsAg and anti-HBc, HBV DNA test if either positive

  • High and moderate risk: prophylaxis

  • Low risk: against routine prophylaxis

 Antivirals with highbarrier to resistance over lamivudine

  • At least 6 months after discontinuation of immunosuppressive therapy

  • At least 12 months for B cell–depleting agents

 Not mentioned
The Asian Pacific Association for the Study of the Liver (APASL) 2016 guideline [7] All patients HBsAg and anti-HBcAb, HBsAg (−), anti-HbcAb (+): HBV DNA

  • HBsAg (+): prophylaxis

  • Resolved HBV with detectable HBV DNA: treated as HBsAg (+)

  • Resolved HBV with undetectable HBV DNA: on demand therapy, except anti-CD20 antibody therapy or stem cell transplantation (monitor ALT and HBV DNA every 1–3 months)

 ETV, TDF At least 12 months after cessation of therapy Not mentioned
European Association for the Study of the Liver (EASL) 2017 guideline [3] All patients HBsAg, anti-HbcAb, and anti-HbsAb

  • HBsAg (+): prophylaxis

  • Resolved HBV, high risk: prophylaxis

  • Resolved HBV, moderate and low risk: on- demend therapy (monitor HBsAg and/or HBV DNA every 1–3 months)

 ETV, TDF, TAF

  • At least 12 months after cessation of the immunosuppressive treatment

  • At least 18 months for rituximab-based regimens

 Liver function tests and HBV DNA should be tested every 3 to 6 months and for at least 12 months after NAs withdrawal
Korean Association for the Study of the Liver (KASL) 2019 guideline [8] All patients HBsAg and anti-HbcAb, HBV DNA test if either positive

  • HBsAg (+) or HBV DNA detectable: prophylaxis

  • Resolved HBV anti-CD20 antibody therapy or stem cell transplantation: prophylaxis

  • Resolved HBV moderate or low risk: on- demend therapy (monitor HBsAg and HBV DNA every 1–3 months)

 ETV, TDF

  • At least 6 months after the chemotherapy is completed

  • At least 12 months for rituximab-based regimens after the completion of chemotherapy

 Not mentioned
American Society of Clinical Oncology (ASCO) 2020 update [9] All patients HBsAg, anti-HBcAb, and anti-HBsAb

  • HBsAg (+): prophylaxis

  • Resolved HBV, high risk, e.g., anti-CD20 antibody therapy or stem cell transplantation: prophylaxis

  • Resolved HBV, other therapy: on-demend therapy (monitor HBsAg and HBV DNA every 3 months)

 ETV, TDF, TAF

  • At least 12 months after cessation of the immunosuppressive treatment

  • HBsAg (+) and resolved HBV with high risk: monthly for the first 3 months after NAs withdrawal and then every 3 months, no comment on duration

  • Resolved HBV, no high risk: not necessary

ETV: entecavir, HBV: hepatitis B virus, NAs: nucleotide analogues, TDF: tenofovir, TAF: Tenofovir alafenamide fumarate.