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Latent tuberculosis before biologic therapy — RCPSC IM MCQ

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HardInfectious DiseasesLatent tuberculosis before biologic therapyRCPSC IM

A patient scheduled for rituximab has negative HBsAg, positive total anti-HBc and undetectable HBV DNA. What is the safest approach to hepatitis B reactivation risk?

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Correct answer: B — Give high-barrier antiviral prophylaxis with protocolized monitoring

The best answer is “Give high-barrier antiviral prophylaxis with protocolized monitoring”. Resolved HBV markers do not eliminate reactivation risk during B-cell depletion, and rituximab is a high-risk exposure. Prophylactic entecavir or tenofovir-class therapy plus monitoring prevents severe hepatitis; vaccination does not treat latent intrahepatic virus, and waiting for hepatitis is unsafe.

Reference: Canadian Association for the Study of the Liver, hepatitis B management guideline: https://pmc.ncbi.nlm.nih.gov/articles/PMC9202759/