Clinical Impact of Routine HBV Screening in Oncologic Patients Prior to Chemotherapy

Area of Science:

• Oncology
• Hepatology
• Infectious Diseases

Background:

• Hepatitis B virus (HBV) reactivation during chemotherapy poses a significant risk of severe hepatitis, hepatic failure, and death.
• Current HBV screening practices in oncology are inconsistent, and guidelines are evolving.
• Early identification of HBV infection is vital to mitigate chemotherapy-related complications.

Purpose of the Study:

• To assess the effectiveness of universal Hepatitis B virus (HBV) screening in oncology patients.
• To evaluate the identification of active HBV infection, prior exposure, and reactivation risk.
• To compare universal screening with risk-based strategies.

Main Methods:

• Implementation of universal HBV screening (HBsAg, anti-HBc, anti-HBs) for all patients starting chemotherapy.
• Retrospective analysis of 1614 oncology patients from January 2018 to April 2024.
• HBV DNA testing for HBsAg and/or anti-HBc positive cases; exclusion of known HBsAg positive or treated patients.

Main Results:

• 1.0% (16/1614) of patients were HBsAg-positive; 8.3% (134/1614) were HBsAg-negative/anti-HBc-positive.
• 3% (4/134) of HBsAg-negative/anti-HBc-positive patients had detectable HBV DNA.
• Universal screening identified more at-risk patients than the 2015 ASCO risk-based guidelines.

Conclusions:

• Universal HBV screening effectively identifies patients with active or prior HBV infection missed by risk-based approaches.
• This strategy is essential for preventing HBV reactivation and its severe consequences in cancer patients.
• Supports the routine implementation of universal HBV screening in oncology settings.