HBV DNA Monitoring Chemotherapy — SCE Infectious Diseases MCQ

Correct answer: E — Monthly HBV DNA during chemotherapy and for at least 12 months after completion (or longer if Rituximab was used — 12–18 months post-last dose)

HBV reactivation during immunosuppressive chemotherapy may be asymptomatic initially and is detected virologically before clinical hepatitis develops, so symptom-triggered or annual/6-monthly testing is unsafe. In UK practice, patients with chronic HBV who are starting immunosuppressive systemic anticancer therapy should be managed with specialist hepatology input, antiviral prophylaxis where indicated, and close HBV DNA surveillance. For this SBA, the required monitoring schedule is monthly HBV DNA during chemotherapy and continued for at least 12 months after completion; if rituximab or another B-cell-depleting regimen is used, monitoring/prophylaxis must be extended because delayed HBV reactivation is well recognised, typically to 12–18 months after the last dose. Therefore the correct option is C.

Reference: UK Chemotherapy Board. Position Statement on Hepatitis B Virus Screening and Reactivation Prophylaxis for Patients Planned to Receive Immunosuppressive SACT. 2022. https://wmcanceralliance.nhs.uk/component/rsfiles/file-path/files?Itemid=236&path=EAGs%2FSystemic%2BAnti-Cancer%2BTherapy%2BSACT%2FGuidelines%2FUKCB%2Bstatement-%2BHBV%2Bscreening%2BJan%2B2022_FINAL%2Bversion1a.pdf