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HBV Reactivation on Rituximab — RACP Adult Medicine MCQ

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ModerateInfectious DiseasesHBV Reactivation on RituximabRACP Adult Medicine

A 40-year-old man with known chronic hepatitis B (on tenofovir) is about to commence rituximab for DLBCL. HBsAg is positive, HBV DNA is undetectable on tenofovir. What is the most important precaution regarding HBV?

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Correct answer: A — Continue tenofovir throughout and for 12 months after rituximab

HBsAg-positive patients receiving rituximab (potent B-cell depletion) are at very high risk of HBV reactivation (up to 70% without prophylaxis). Antiviral prophylaxis with tenofovir (or entecavir) must be continued throughout immunosuppressive therapy and for AT LEAST 12-18 months after the last rituximab dose (B-cell reconstitution takes 6-12 months). Monitor HBV DNA every 3 months during and after treatment. HBV reactivation can cause fulminant hepatitis and death.

Reference: GESA – 2022 – HBV Reactivation; AASLD 2024; eTG Antibiotic 2025