Published online Sep 28, 2015. doi: 10.4254/wjh.v7.i21.2344
Peer-review started: April 22, 2015
First decision: July 25, 2015
Revised: August 19, 2015
Accepted: September 7, 2015
Article in press: September 8, 2015
Published online: September 28, 2015
Rituximab is currently used not only in the treatment of B-cell lymphoma but also for various other diseases, including autoimmune diseases, post-transplant graft vs host disease, and rejection following kidney transplants. Due to rituximab’s widespread use, great progress has been made regarding research into complications that arise from its use, one of the most serious being the reactivation of hepatitis B virus (HBV), and efforts continue to establish guidelines for preventive treatment against this occurrence. This report discusses preventive measures against rituximab-induced HBV reactivation and future objectives.
Core tip: For preventive measures against hepatitis B virus (HBV) reactivation during rituximab treatment, hepatitis B surface (HBs) antigen positive and HBc antibody positive/HBs antibody negative patients are subject to prophylactic treatment with nucleoside analogs. During rituximab treatment, the HBV-DNA levels of patients who are HBc antibody positive (HBs antibody positive or negative) are ideally monitored with PCR once a month. If the PCR results are positive, the administration of nucleoside analogs is initiated. However, since monitoring HBV-DNA levels is expensive, it might be preferable to follow the HBs antibodies instead. Due to wide differences in the insurance situations in each country, including the follow-up intervals, further research must determine ideal follow-up intervals. However, no standard exists for the timing of this treatment’s termination. For HBs antigen negative patients who also receive nucleoside analog treatment, it will be necessary in the future to evaluate the possibility of switching to a vaccine when a patient becomes HBs antibody positive.