Hepatitis B can reactivate during chemotherapy, high-dose steroids, rituximab and some other immunosuppressants or biologics, sometimes causing severe hepatitis or liver failure. This applies to people with chronic infection and to those with resolved infection who are surface-antigen negative but core-antibody positive.
Before starting such treatment, check HBsAg and total anti-HBc, and an anti-HBs level if that fits local practice. If either marker is positive, check HBV DNA and discuss antiviral prophylaxis or monitoring with a hepatologist before the first dose. In a region with a substantial burden of hepatitis B, make this a routine part of the pre-treatment checklist rather than a risk-based decision.
- Test HBsAg and anti-HBc before chemotherapy or immunosuppression.
- Check HBV DNA if either marker is positive.
- Arrange prophylaxis or monitoring before the first dose.
- Make the screen part of the standard pre-treatment checklist.
Why it matters
Reactivation is largely preventable if the infection is found before treatment starts.
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