Hepatitis B can reactivate when the immune system is suppressed, including in people who clear the surface antigen or who are known only as carriers. Reactivation can cause severe hepatitis and liver failure, and it is largely preventable.
Before chemotherapy, a rituximab-containing regimen, a biologic or high-dose steroids, check hepatitis B surface antigen and core antibody, and send HBV DNA where either is positive. Positive patients need antiviral prophylaxis or close monitoring, guided by a hepatologist.
- Send HBsAg and anti-HBc total before starting immunosuppression or chemotherapy.
- Check HBV DNA if either is positive.
- Start antiviral prophylaxis or monitoring on specialist advice, before treatment begins.
- Continue prophylaxis for the period recommended after the immunosuppression ends.
Why it matters
Reactivation is among the most preventable causes of severe hepatitis in treated patients.
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