Hepatitis B virus reactivation with a rituximab-containing regimen

Core Tip

Core tip: For preventive measures against hepatitis B virus (HBV) reactivation during rituximab treatment, hepatitis B surface (HBs) antigen positive and HBc antibody positive/HBs antibody negative patients are subject to prophylactic treatment with nucleoside analogs. During rituximab treatment, the HBV-DNA levels of patients who are HBc antibody positive (HBs antibody positive or negative) are ideally monitored with PCR once a month. If the PCR results are positive, the administration of nucleoside analogs is initiated. However, since monitoring HBV-DNA levels is expensive, it might be preferable to follow the HBs antibodies instead. Due to wide differences in the insurance situations in each country, including the follow-up intervals, further research must determine ideal follow-up intervals. However, no standard exists for the timing of this treatment’s termination. For HBs antigen negative patients who also receive nucleoside analog treatment, it will be necessary in the future to evaluate the possibility of switching to a vaccine when a patient becomes HBs antibody positive.