Introduction

Patients with hepatitis B or past exposure to hepatitis B virus (HBV) who receive cancer chemotherapy or other immunosuppressive therapy are at risk of reactivation of hepatitis B infection, and antiviral prophylaxis may be indicated. Prophylaxis has been shown to reduce rates of HBV-associated hepatitis, severe flares and death. The decision on whether to give antiviral prophylaxis should be made in consultation with a specialist.

As well as identifying patients at risk of hepatitis B reactivation, testing may also identify patients with previously unrecognised active hepatitis B infection that requires treatment regardless of cancer chemotherapy or immunosuppressive therapy. If patients fulfil the treatment criteria for chronic hepatitis B infection (see Indications for antiviral therapy), they should be treated and remain on therapy according to standard treatment recommendations (see Management of chronic hepatitis B: Antiviral therapy and monitoring).

Patients without evidence of prior exposure to HBV (ie hepatitis B surface antigen [HBsAg] negative and hepatitis B core antibody [anti-HBc] negative) do not require antiviral prophylaxis, but consider hepatitis B vaccination in these patients.

Antiviral therapy to reduce the risk of hepatitis B reactivation during cancer chemotherapy or immunosuppression is not subsidised by the Pharmaceutical Benefits Scheme (PBS), unless the patient meets the PBS criteria for treatment of chronic hepatitis B (see the PBS website for current information).

For more information about management of hepatitis B during immunosuppression see the Australian consensus recommendations for the management of hepatitis B infection, available online. For more information specifically on the management of hepatitis B during immunosuppression for haematological and solid organ malignancies, see Hepatitis B management during immunosuppression for haematological and solid organ malignancies: An Australian consensus statement, available online.