Related Experiment Video
Updated: Jun 5, 2026
10:37
Analysis of HBV-Specific CD4 T-cell Responses and Identification of HLA-DR-Restricted CD4 T-Cell Epitopes Based on a Peptide Matrix
Published on: October 20, 2021
Hepatitis B Screening, Antiviral Prophylaxis, and Reactivation Risk in Rituximab-Treated Patients: A 17-Year
Fadi Abu Baker1,2, Mifleh Tatour3,4,5, Ahmad Yehya6
1Department of Gastroenterology and Hepatology, Hillel Yaffe Medical Center, Hadera, Israel.
Digestive Diseases and Sciences
|June 4, 2026
Summary
Hepatitis B virus (HBV) reactivation is a risk with rituximab, but screening and prophylaxis remain insufficient. System-level changes are needed to improve adherence to guidelines and prevent adverse outcomes.
Area of Science:
- Immunology
- Hepatology
- Oncology
Background:
- Hepatitis B virus (HBV) reactivation poses a significant risk during immunosuppressive therapy, especially with anti-CD20 agents like rituximab.
- Effective screening and prophylactic measures are crucial to mitigate severe outcomes associated with HBV reactivation.
Purpose of the Study:
- To evaluate the rates and temporal trends of Hepatitis B virus (HBV) screening and antiviral prophylaxis in patients receiving rituximab.
- To identify the incidence of HBV reactivation and its predictors in a real-world clinical setting.
Main Methods:
- A retrospective population-based cohort study was conducted using the Clalit Health Services database in northern Israel from 2005 to 2022.
- Adult patients (≥18 years) receiving rituximab were analyzed for HBV screening (HBsAg, anti-HBc) within 90 days before treatment, antiviral prophylaxis, and HBV reactivation events.
- Cox proportional hazards models were used to identify predictors of HBV reactivation.
Main Results:
- Only 10.5% of 11,888 adult patients received timely HBV screening before rituximab initiation; screening rates improved over time but remained suboptimal.
- Approximately 6.0% of screened patients showed evidence of current or prior HBV infection.
- 159 HBV reactivation events occurred (1.3% per patient), predominantly in unscreened patients; male sex was an independent predictor.
Conclusions:
- Despite improvements over two decades, HBV screening before rituximab therapy is insufficient in clinical practice.
- HBV reactivation is largely preventable through appropriate screening and antiviral prophylaxis.
- System-level interventions are necessary to enhance adherence to recommended HBV screening and prophylaxis guidelines.
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