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Updated: Jan 7, 2026
Stem Cell-Derived Viral Ag-Specific T Lymphocytes Suppress HBV Replication in Mice
Published on: September 25, 2019
Meta-Analysis: High anti-HBs Titers are Associated with Significantly Reduced Risk of Hepatitis B Virus Reactivation
Shiva Poola1, MaryKate Kratzer1, Kerry Sewell2
1Department of Medicine, Division of Gastroenterology, Hepatology & Nutrition, Brody School of Medicine, East Carolina University/ECU Health Medical Center, Greenville, North Carolina, USA.
Background:
Hepatitis B virus (HBV) reactivation is a serious complication in patients receiving chronic immunosuppression. Anti-CD20 agents such as Rituximab are considered high risk for HBV reactivation (> 10%); therefore, antiviral prophylaxis is recommended for all anti-HBc positive patients. Some studies have suggested that patients with resolved HBV infection and higher hepatitis B surface antibody (anti-HBs) titer have a higher level of protection against reactivation.
Aim:
The purpose of this study was to systematically review the role of anti-HBs titer on HBV reactivation in patients on rituximab while not on antiviral therapy/prophylaxis.
Methods:
We systematically reviewed all studies that discussed HBV reactivation in patients on rituximab therapy with resolved HBV infection, defined as HBsAg negative and anti-HBc positive, which discussed anti-HBs titer. The search was conducted in PubMed, Embase via Elsevier, Scopus, and Cochrane CENTRAL inclusive July 2025. We evaluated the incidence of HBV reactivation from cohort studies that described anti-HBs categorically based on anti-HBs titer: 'negative' (titer < 10 iU/L), '10-100 iU/L', or '> 100 iU/L'. Meta-analysis statistics describe the proportion and risk difference for different anti-HBs levels.
Results:
The overall reactivation rate was 12.6%. There was a significant difference in HBV reactivation depending on titer: anti-HBs negative 27.3% (51/195) (20.0%-36.0%), titer < 100 iU/L 13.8% (47/379) (8.8%-20.8%), and titer > 100 iU/L 3.5% (8/339) (1.8%-6.9%).
Conclusions:
Those with anti-HBs titer > 100 iU/L can be considered lower risk for HBV reactivation and may not require antiviral therapy, but monitoring with initiation of antiviral therapy if titer falls below 100 iU/L.
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