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Rituximab hepatitis B reactivation risk — SCE Rheumatology MCQ

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HardRheumatological PharmacologyRituximab hepatitis B reactivation riskSCE Rheumatology

A patient is HBsAg negative, anti-HBc positive and HBV DNA undetectable before rituximab for vasculitis. Rituximab cannot be deferred. Which prevention strategy is most appropriate?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: D — Start entecavir or tenofovir prophylaxis before rituximab

Explanation lettering: C = shown as B · B = shown as C · E = shown as D · D = shown as E

E is correct. Anti-CD20 therapy carries high reactivation risk even after apparently resolved HBV infection. BSG guidance supports prophylactic nucleos(t)ide therapy for anti-HBc-positive patients starting rituximab, using high-barrier agents such as entecavir or tenofovir. ALT-only monitoring detects reactivation late; vaccination does not eliminate latent cccDNA, and waiting for DNA positivity abandons prophylaxis.

Reference: British Society of Gastroenterology autoimmune hepatitis guideline. https://gut.bmj.com/content/74/9/1364