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HBV Reactivation with Rituximab — SCE Infectious Diseases MCQ

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HardHepatitisHBV Reactivation with RituximabSCE Infectious Diseases

A 50-year-old man with chronic hepatitis B (HBsAg positive, on Entecavir) requires chemotherapy with Rituximab for non-Hodgkin lymphoma. What is the specific HBV-related risk with Rituximab?

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Correct answer: C — Severe HBV reactivation — Rituximab depletes B-cells including those maintaining anti-HBV immune control; antiviral prophylaxis must be continued throughout and for 12–18 months after last Rituximab dose

Rituximab-associated HBV reactivation is well-documented and can be fatal. B-cell depletion disrupts the immune control of HBV, allowing viral rebound even in patients on antiviral prophylaxis (though prophylaxis dramatically reduces risk). Entecavir (or Tenofovir) must be continued throughout Rituximab therapy AND for at least 12–18 months after the last dose (as B-cell reconstitution is slow). HBV DNA and LFTs should be monitored regularly. This applies to HBsAg-positive patients AND HBsAg-negative/anti-HBc-positive patients (who can also reactivate).

Reference: EASL 2024 – HBV guidelines; NICE CG165 – Hepatitis B; BSH 2023 – HBV reactivation with chemotherapy