Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Sep 28, 2015; 7(21): 2344-2351
Published online Sep 28, 2015. doi: 10.4254/wjh.v7.i21.2344
Hepatitis B virus reactivation with a rituximab-containing regimen
Yutaka Tsutsumi, Yoshiya Yamamoto, Shinichi Ito, Hiroyuki Ohigashi, Souichi Shiratori, Hirohito Naruse, Takanori Teshima
Yutaka Tsutsumi, Shinichi Ito, Hiroyuki Ohigashi, Souichi Shiratori, Department of Hematology, Hakodate Municipal Hospital, Hakodate 041-8680, Japan
Yoshiya Yamamoto, Hirohito Naruse, Department of Gastroenterology, Hakodate Municipal Hospital, Hakodate 041-8680, Japan
Takanori Teshima, Department of Hematology, Hokkaido University Graduate School of Medicine, Sapporo 060-0808, Japan
Author contributions: Tsutsumi Y, Ito S, Ohigashi H, Yamamoto Y, Shiratori S, Naruse H and Teshima T contributed equally to this report.
Conflict-of-interest statement: The authors indicated no potential conflict of interest in this article.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Yutaka Tsutsumi, MD, PhD, Department of Hematology, Hakodate Municipal Hospital, 1-10-1, Minato-cho, Hakodate 041-8680, Japan.
Telephone: +81-138-432000 Fax: +81-138-434426
Received: April 20, 2015
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
Core Tip

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.