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HBV Prophylaxis Duration Post-Rituximab — SCE Infectious Diseases MCQ

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ModerateHepatitisHBV Prophylaxis Duration Post-RituximabSCE Infectious Diseases

A 50-year-old man with treated chronic HBV (HBsAg positive, HBV DNA undetectable on Entecavir) is about to start Rituximab-based chemotherapy for lymphoma. His hepatologist confirms Entecavir should continue throughout. For how long after the last Rituximab dose should HBV antiviral prophylaxis continue?

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Correct answer: E — At least 12–18 months after the last Rituximab dose — B-cell reconstitution is slow after Rituximab, and HBV reactivation risk persists throughout the B-cell depletion period

Rituximab causes prolonged B-cell depletion (6–12 months after the last dose). HBV reactivation risk persists throughout this period because B-cells contribute to anti-HBV immune control. HBV antiviral prophylaxis must continue for at least 12–18 months after the last Rituximab dose (some experts recommend 24 months). HBV DNA and LFTs should be monitored monthly during and after chemotherapy. This applies to BOTH HBsAg-positive patients AND HBsAg-negative/anti-HBc-positive patients (who can also reactivate on Rituximab).

Reference: EASL 2024 – HBV reactivation; BSH 2023 – HBV and chemotherapy; NICE CG165