Table 3.
Guidelines for the screening, management, and monitoring of HBV-R during immunosuppressive therapy.
| Guidelines | Screen object | Management strategies for HBV-R | Duration of antiviral therapy | Monitoring during prophylaxis | Monitoring after prophylaxis |
|---|---|---|---|---|---|
| American Association for the Study of Liver Diseases (AASLD, 2018) (26) |
All patients | Chronic infection: prophylaxis Resolved infection: either prophylaxis or pre-emptive therapy, but prophylaxis is needed when patients are receiving anti-CD20 antibody therapy |
At least 6 months (12 months for patients receiving anti-CD20 antibody therapy) after the completion of immunosuppressive therapy | Not mentioned | HBV DNA levels should be tested every 1–3 months |
| The Asian Pacific Association for the Study of the Liver (APASL, 2016) (27) |
All patients | HBsAg(+) cancer patients: prophylaxis; Resolved HBV with detectable HBV DNA: prophylaxis; Resolved HBV with undetectable HBV DNA: pre-emptive therapy, except with anti-CD20 antibody therapy or stem cell transplantation |
At least 12 months after the cessation of therapy | Resolved HBV with undetectable HBV DNA: ALT and HBV DNA every 1–3 months |
Not mentioned |
| American Gastroenterological Association (AGA, 2015) (30) |
Patients at moderate or high risk of HBV-R | High and moderate risk: prophylaxis; Low risk: routine prophylaxis not recommended |
The same as for AASLD | No recommendation | No recommendation |
| European Association for the Study of the Liver (EASL, 2017) (29) | All patients | HBsAg(+) patients: prophylaxis; Resolved HBV, high risk: prophylaxis; Resolved HBV, moderate and low risk: pre-emptive therapy (monitor HBsAg and HBV DNA every 1–3 months) |
At least 12 months after the cessation of immunosuppressive treatment and at least 18 months for rituximab-based regimens | Not mentioned | Liver function tests and HBV DNA should be tested every 3–6 months |
| American Society of Clinical Oncology (ASCO, 2020) (73) | All cancer patients | HBsAg(+) patients: prophylaxis; Resolved HBV, high risk: prophylaxis; Resolved HBV, moderate and low risk: pre-emptive therapy (monitor HBsAg and HBV DNA every 3 months) |
For a minimum of 12 months following anticancer therapy |
ALT and HBV DNA levels should be tested every 6 months during antiviral therapy | HBsAg(+) and resolved HBV with high risk: at least monthly for the first 3 months after the cessation of antiviral therapy and every 3 months thereafter |
HBsAg, hepatitis B surface antigen; ALT, alanine aminotransferase.