title: Giving rituximab in patients with occult or resolved hepatitis B virus infection: are the current guidelines good enough?
abstract: BACKGROUND
  Hepatitis B virus (HBV) reactivation after 'resolved' infection can occur in the setting of immunosuppression, including iatrogenically induced by anti-CD20 antibodies. The presence of antibodies against the HBV core antigen (anti-HBc) is a marker of risk for this phenomenon. The risk of this occurring in patients with circulating HBV surface antigen (HBsAg) is well characterized, but is less well characterized in patients who are HBsAg negative.
  
  
  METHODS
  This article reviews the literature regarding HBV reactivation in the context of rituximab therapy. We have limited our review to HBsAg-negative patients, and clinical outcomes following HBV reactivation.
  
  
  CONCLUSIONS
  We have recommended prophylactic anti-viral therapy for all HBsAg-negative/anti-HBc-positive patients undergoing rituximab therapy in combination with other immunosuppressive therapy.
authors.affiliation: Thomas Jefferson University, Division of Gastoenterology and Hepatology, Department of Medicine , Philadelphia, PA 19107 , USA.
authors.forename: Jesse
authors.initials: J
authors.lastname: Civan
authors.forename: Hie Won
authors.initials: HW
authors.lastname: Hann
mesh_terms: D000998:Antiviral Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D006509:Hepatitis B / Q000517:prevention & control* / Q000821:virology; D006512:Hepatitis B Core Antigens / Q000097:blood; D006514:Hepatitis B Surface Antigens / Q000097:blood; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000009:adverse effects; D017410:Practice Guidelines as Topic; D000069283:Rituximab / Q000008:administration & dosage / Q000009:adverse effects*; D014775:Virus Activation / Q000187:drug effects
chemical_list: D000998:Antiviral Agents; D006512:Hepatitis B Core Antigens; D006514:Hepatitis B Surface Antigens; D007166:Immunosuppressive Agents; D000069283:Rituximab
keywords: CD20 monoclonal antibodies; anti-hepatitis B virus core antigen; chemotherapy; hepatitis B virus; hepatitis B virus surface antigen negative/anti-HBc positive; immunosuppression; reactivation of hepatitis B virus; retuximab