Risk of hepatitis B virus reactivation in cancer patients undergoing treatment with tyrosine kinase-inhibitors

Table 1 Risk-based approach to hepatitis B virus reactivation management

Patient category	Risk of HBV reactivation	Recommended approach
HBsAg-positive patients without hepatitis at baseline	High	Prophylactic NAT before immunosuppressive therapy
HBsAg-negative and anti-HBc-positive patients	Varies; depends on HBV DNA level and immunosuppressive regimen	If HBV DNA detectable: Prophylactic NAT; if HBV DNA undetectable: Assess risk of reactivation; high-risk groups receive prophylactic NAT, moderate/low-risk groups undergo pre-emptive treatment with HBV DNA monitoring
HBsAg-negative/anti-HBc-negative/anti-HBs-negative	Moderate	Consider HBV vaccination; the presence of anti-HBs is associated with a lower risk of reactivation
HBsAg-negative/anti-HBc-negative/anti-HBs-positive	Rare	Monitor closely; occasional reports of reactivation despite anti-HBs positivity

HBV: Hepatitis B virus; HBVr: Hepatitis B virus reactivation; NAT: Nucleos(t)ide analog therapy; HBsAg: Hepatitis B surface antigen; HBc: Hepatitis B core antigen; HBs: Hepatitis B surface antibody.