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Hepatitis B reactivation prevention — ESEGH MCQ

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HardHepatologyHepatitis B reactivation preventionESEGH

A 64-year-old man with HBsAg positivity is due to receive rituximab and bendamustine for lymphoma. ALT is normal, HBV DNA is 1,200 IU/mL and anti-HBc is positive. He has no cirrhosis on transient elastography. What is the most appropriate management?

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Correct answer: D — Start entecavir or tenofovir before immunochemotherapy

Rituximab carries a high risk of HBV reactivation, and HBsAg-positive patients should receive potent nucleoside analogue prophylaxis before treatment. Monitoring alone is unsafe in this high-risk setting. Vaccination does not treat established infection. The teaching point is that immunosuppression can reactivate HBV despite normal baseline ALT.

Reference: EASL Hepatitis B Guideline 2025; BNF