Table 3

Pre-emptive hepatitis B treatment before chemotherapy

HBsAgAnti-HBcHBV DNARecommendation
+N/A<2000 IU/mL
  • Finite and short duration of CHT: lamivudine may suffice;

  • Lengthy and repeated cycles of CHT: NA with higher potency and barrier to resistance, ie, tenofovir or entecavir

+N/A>2000 IU/mLNA with higher potency and barrier to resistance, ie, tenofovir or entecavir
+UndetectableClose monitoring of ALT and HBV DNA (1–3 monthly), treat with NA on confirmation of HBV reactivation; consider prophylaxis in special indications, ie, bone marrow or stem cell transplantation, rituximab and/or combined regimens for hematological diseases
+DetectableTreat similarly to HBsAg+patients
  • ALT, alanine aminotransferase; anti-HBc, hepatitis B core antibodies; CHT, chemotherapy; HBsAg, hepatitis B surface antigen; HBV DNA, hepatitis B virus deoxyribonucleic acid; N/A, not applicable; NA, nucleoside analogues.