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HBV Serologic Testing Practices and Reactivation Outcomes Before Rituximab Initiation: A Retrospective Observational
Ahmed S Barefah1,2, Omar M Raslan3, Hatem M Alahwal1,2
1Hematology Department, Faculty of Medicine, King Abdulaziz University Hospital, King Abdulaziz University, Jeddah 21589, Saudi Arabia.
Journal of Clinical Medicine
|August 13, 2026
Summary
Hepatitis B virus (HBV) reactivation is a significant risk for patients on rituximab, leading to serious illness and death. Universal HBV testing and antiviral prophylaxis are crucial before initiating rituximab treatment.
Area of Science:
- Hepatology
- Immunology
- Oncology
Background:
- Hepatitis B virus (HBV) infection poses global health risks, including cirrhosis and liver cancer.
- Rituximab treatment can trigger HBV reactivation due to immunosuppression, especially in B-cell depletion.
- Identifying HBV reactivation risks is critical for patient management during rituximab therapy.
Purpose of the Study:
- To assess HBV serologic testing practices before rituximab initiation.
- To determine the incidence and outcomes of HBV reactivation in rituximab-treated patients.
- To evaluate the need for standardized HBV protocols in rituximab recipients.
Main Methods:
- Retrospective observational study of 611 patients receiving rituximab (2010-2020).
- Data collected from electronic medical records, including demographics, clinical, and laboratory results.
- HBV reactivation defined by American Association for the Study of Liver Diseases (AASLD) criteria.
Main Results:
- HBV testing documented in 60.8% (hematological) and 71.7% (non-hematological) of patients.
- HBV reactivation occurred in 3.4% of hematological malignancy patients (all lymphoma).
- Reactivation led to significant morbidity and 28% liver-related mortality; only 9 patients received prophylaxis.
Conclusions:
- Inconsistent HBV serologic testing and limited antiviral prophylaxis use were observed.
- HBV reactivation poses substantial morbidity and mortality risks in rituximab-treated patients.
- Systematic HBV evaluation and prophylaxis protocols are essential for patients undergoing rituximab therapy.
