Hepatitis B virus reactivation with a rituximab-containing regimen

Table 1 Guidelines for chemotherapy or immunosuppressive drug therapy

AASLD	Subject to preventive treatment if HBsAg positive or anti-HBc positive and HBV-DNA positive. If HBV-DNA concentration is less than 20000 IU or for a shortened treatment (< 1 yr), lamivudine or telbivudine is desirable. If HBV-DNA concentration exceeds 20000 IU and long-term treatment is necessary, entecavir or tenofovir is desirable. lf HBV-DNA concentration remains less than 2000 IU six months after the completion of treatment, the treatment should be discontinued; otherwise treatment shall continue (2009)
APASL	There are no guidelines (2005)
EASL	HBsAg cases are subject to treatment, and HBV-DNA is measured in these cases, although there is no defined value in which treatment recommendations can be made. Lamivudine is most commonly used; however, it is best used in cases with low HBV-DNA concentration or when resistant strains are less likely to emerge. In high HBV-DNA concentration cases or when there is a high risk of resistance, entecavir is desirable. Careful follow-up of HBV-DNA concentration and liver function is necessary for HBsAg negative, Anti-HBc positive, and HBV-DNA negative cases. Vaccination is recommended in HBV seronegative cases (2009)
JAPAN	Subject to nucleoside analog treatment if HBsAg positive or if HBsAg negative, and anti-HBs or HBc positive plus HBV-DNA positive. If HBV-DNA is negative, HBV-DNA is monitored monthly and nucleoside analogs are administered when HBV-DNA becomes positive. Entecavir is recommended as the nucleoside analog. The timing of the termination of the nucleoside analog treatment shall be determined in accordance with the treatment for type B chronic hepatitis if HBsAg is positive. If the patient is anti-HBs or anti-HBc positive, a nucleoside analog is administered for 12 mo after the completion of immunosuppressive therapy or chemotherapy. During this time, nucleoside analog treatment will be discontinued if HBV-DNA is negative and ALT is normal. Patients are closely observed for 12 mo after treatment with nucleoside analogs (2009)

HBsAg: Hepatitis B surface antigen; HBV: Hepatitis B virus; ALT: Alanine aminotransferase.