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Isolated Anti-HBc Chemo Risk — RACP Adult Medicine MCQ

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ModerateInfectious DiseasesIsolated Anti-HBc Chemo RiskRACP Adult Medicine

A 45-year-old woman with breast cancer is about to receive adjuvant chemotherapy (anthracycline + cyclophosphamide). She is HBsAg negative, anti-HBc positive, anti-HBs negative (isolated anti-HBc). HBV DNA is undetectable. What is the HBV reactivation risk with standard chemotherapy?

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Correct answer: B — Moderate risk (1-10%) — monitor HBV DNA, pre-emptive therapy if positive

Isolated anti-HBc positive (HBsAg neg, anti-HBs neg) with standard chemotherapy (not anti-CD20) has moderate HBV reactivation risk (1-10%). AASLD 2024: monitor HBV DNA every 1-3 months during chemo and for 6 months after. If HBV DNA becomes detectable → start antiviral immediately (pre-emptive approach). Prophylactic antivirals are preferred for higher-risk regimens (anti-CD20, high-dose steroids, anthracycline-based, stem cell transplant). The clinical situation determines the strategy.

Reference: GESA – 2022 – HBV Reactivation; AGA 2024; AASLD 2024