Hepatitis B testing before cancer chemotherapy or immunosuppression

Patients who will receive cancer chemotherapy or other significant immunosuppressive therapy

All patients about to undergo cancer chemotherapy or other significant immunosuppressive therapy, including those receiving prednisolone 20 mg or more daily for more than 2 weeks (or the equivalent dose of another corticosteroid), should be tested for hepatitis B¹. Measure hepatitis B surface antigen (HBsAg), hepatitis B core antibody (anti-HBc) and hepatitis B surface antibody (anti-HBs).

Patients who test HBsAg positive are at risk of hepatitis B reactivation with a severe flare that may lead to fatal liver failure. These patients should have their hepatitis B disease fully assessed with hepatitis B e antigen (HBeAg), hepatitis B e antibody (anti-HBe), HBV DNA, liver biochemistry and transient elastography. For patients who fulfil the treatment criteria for chronic hepatitis B infection, see Management of chronic hepatitis B: Antiviral therapy and monitoring. For all other patients, see Patients who are hepatitis B surface antigen (HBsAg) positive.

The risk of hepatitis B reactivation in patients who are HBsAg negative and anti-HBc positive varies depending on the type of chemotherapy they receive—see Patients who are hepatitis B surface antigen (HBsAg) negative and hepatitis B core antibody (anti-HBc) positive.

Patients who will receive short courses of low-dose corticosteroids

Routine testing of hepatitis B status is not required for patients receiving a short course (ie less than 14 days) of a corticosteroid at a low dose (prednisolone less than 20 mg daily, or the equivalent dose of another corticosteroid), because this is associated with a low risk of a hepatitis B flare. However, these patients should be offered testing before immunosuppressive therapy if they meet other criteria for hepatitis B testing (see Testing for hepatitis B).