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Delayed Hepatitis B Virus Reactivation at 33 Months after the Completion of Rituximab-based Chemotherapy
Banri Ogawa1, Toshiro Kamoshida1, Asaji Yamamoto1
1Department of Gastroenterology, Hitachi General Hospital, Japan.
Internal Medicine (Tokyo, Japan)
|April 13, 2025
Summary
Hepatitis B virus (HBV) reactivation occurred in an elderly patient with isolated anti-HBc antibodies during rituximab chemotherapy. Reactivation led to hepatic failure, but Tenofovir alafenamide fumarate treatment was effective.
Area of Science:
- Hepatology
- Oncology
- Immunology
Background:
- Hepatitis B virus (HBV) reactivation is a concern in immunosuppressed patients.
- Isolated anti-HBc antibodies (IAHBc) seropositivity indicates past HBV exposure and potential risk.
- Rituximab-based chemotherapy can increase the risk of HBV reactivation.
Purpose of the Study:
- To report a case of HBV reactivation in a patient with IAHBc.
- To highlight the delayed HBV reactivation post-rituximab treatment.
- To document the clinical course and management of HBV reactivation.
Main Methods:
- Case report of a female patient in her 70s with follicular lymphoma.
- Patient received rituximab-based chemotherapy.
- Monitoring of HBV serological markers and HBV DNA levels.
- Treatment of HBV reactivation with Tenofovir alafenamide fumarate.
Main Results:
- The patient presented with isolated anti-HBc antibodies (HBsAg-negative, HBsAb-negative, HBcAb-positive) and negative HBV DNA initially.
- Delayed HBV reactivation occurred 33 months after completing 21 months of rituximab treatment.
- HBV DNA levels increased significantly, leading to hepatic failure.
- Tenofovir alafenamide fumarate treatment resulted in undetectable HBV DNA within 9 months.
Conclusions:
- HBV reactivation can occur late after rituximab cessation in patients with IAHBc.
- IAHBc status should prompt vigilance for HBV reactivation in patients undergoing immunosuppressive therapy.
- Early antiviral treatment is crucial for managing HBV reactivation and preventing hepatic failure.

