Background Reactivation of hepatitis B virus (HBV) is a well-recognised complication in patients with chronic HBV infection who receive cytotoxic or immunosuppressant treatment.
Patients undergoing rituximab treatment should be checked routinely for HBV serologic markers and serum HBV DNA levels and this is not a fully established practice.
Purpose To assess whether prophylaxis to prevent HBV reactivation in patients treated with rituximab is being initiated in line with the recommendations of reference guides.
Material and methods Patients treated with rituximab from January 2013 to May 2014 were selected, the HBV serology reviewed, and whether they received prophylaxis with antivirals.
Results 94 patients received rituximab, 9 patients were excluded due to death. Serology requested at baseline was HBs Ag and anti-HBc. 72/83 (87%) patients were seronegative. 11/83 (13%) were positive for HBsAg and anti-HBc. 6/11 (54%) had been given prophylaxis, two with lamivudine 100 mg/day, two with entecavir 0.5 mg/day, one with Tenofovir 245 mg/day and the last with tenofovir/emtricitabine. In two of the cases treatment began after rituximab had been started.
5/11 received no prophylaxis. In one HBV reactivation occurred within three months of the start of rituximab with blood tests becoming positive, significant increase in serology and DNA but without clinical involvement. This patient received entecavir 0.5 mg/day following reactivation.
Conclusion Every patient undergoing rituximab treatment should be checked for HBsAg and total anti-HBc before the initiation of treatment.
It is very important to identify patients who have a serological risk of developing fulminant hepatitis with associated HBV reactivation. These are patients with HBs Ag− with anti-HBc+. Prophylaxis should begin one week before and continue for up to 6–12 months after the end of rituximab treatment.
Guidelines: Journal of Hepatology
ReferenceNo conflict of interest.
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