Meta-Analysis: High anti-HBs Titers are Associated with Significantly Reduced Risk of Hepatitis B Virus Reactivation...

Area of Science:

• Immunology
• Hepatology
• Virology

Background:

• Hepatitis B virus (HBV) reactivation is a significant risk for patients on immunosuppression, particularly with anti-CD20 agents like Rituximab.
• Antiviral prophylaxis is standard for anti-HBc positive patients, but the role of anti-HBs titer in predicting reactivation risk is debated.

Purpose of the Study:

• To systematically review the impact of hepatitis B surface antibody (anti-HBs) titer on HBV reactivation risk in patients receiving rituximab therapy without antiviral prophylaxis.
• To evaluate if anti-HBs titer can stratify patients into different risk categories for HBV reactivation.

Main Methods:

• A systematic review of studies reporting HBV reactivation in HBsAg-negative, anti-HBc-positive patients on rituximab, categorized by anti-HBs titer (<10 IU/L, 10-100 IU/L, >100 IU/L).
• Searches conducted in PubMed, Embase, Scopus, and Cochrane CENTRAL up to July 2025.
• Meta-analysis used to determine reactivation proportions and risk differences across anti-HBs titer groups.

Main Results:

• The overall HBV reactivation rate was 12.6%.
• Reactivation rates varied significantly by anti-HBs titer: 27.3% for negative, 13.8% for <100 IU/L, and 3.5% for >100 IU/L.
• A statistically significant inverse correlation was observed between anti-HBs titer and HBV reactivation risk.

Conclusions:

• Patients with anti-HBs titer >100 IU/L demonstrate a lower risk of HBV reactivation during rituximab therapy.
• These patients may not require routine antiviral prophylaxis, but continuous monitoring of anti-HBs levels is advised.
• Initiation of antiviral therapy should be considered if anti-HBs titers fall below 100 IU/L.