Hepatitis B can reactivate during chemotherapy, rituximab, high-dose steroids, JAK inhibitors and anti-TNF therapy, sometimes fatally. Reactivation also occurs in people who are HBsAg-negative but anti-HBc-positive, which is common in India.
Testing before treatment allows prophylaxis or monitoring to be planned; testing after hepatitis appears is often too late.
- Test HBsAg and anti-HBc before chemotherapy, rituximab, prolonged high-dose steroids or biologic therapy.
- HBsAg-positive patients usually need antiviral prophylaxis during and after high-risk immunosuppression.
- For anti-HBc-positive, HBsAg-negative patients, plan prophylaxis or regular HBV DNA monitoring according to the drug's risk.
- Continue prophylaxis for the recommended period after immunosuppression ends; reactivation can occur late.
Why it matters
Hepatitis B reactivation is preventable, but only if the infection is known before treatment starts.
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