Guidelines for hepatitis B virus (HBV) screening among patients with cancer have been updated, according to a special article published in the Journal of Clinical Oncology.

Jessica P. Hwang, M.D., from the University of Texas MD Anderson Cancer Center in Houston, and colleagues provide an updated provisional clinical opinion based on the American Society of Clinical Oncology panel consensus for HBV screening.

The authors note that patients should be screened for HBV infection before starting anti-CD20 therapy or hematopoietic cell transplantation. Patients with risk factors for HBV infection should also be screened. 

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Screening should include hepatitis B surface antigen (HBsAg) and hepatitis B core antibody (anti-HBc), using the total anti-HBc or anti-HBc immunoglobulin G test.

Antiviral therapy for HBsAg-positive/anti-HBc-positive patients should be started before or simultaneously with cancer therapy; HBsAg-negative/anti-HBc-positive patients should be monitored for reactivation with HBV DNA and alanine aminotransferase levels and treated with antivirals if reactivation occurs.

For HBsAg-negative/anti-HBc-positive patients anticipating cancer therapies associated with a high risk of reactivation, clinicians can initiate antivirals, or they can monitor patients and initiate on-demand antivirals.

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HBV screening is not supported for patients who have neither HBV risk factors nor anticipate cancer therapy associated with a high risk of reactivation.

“Overall, the panel recommends collaboration between oncology and hepatitis B experts to identify key clinical and research areas to reduce the incidence of HBV reactivation and to disseminate and implement scientific discoveries,” the authors write.

Several authors disclosed financial ties to the pharmaceutical and biotechnology industries.


  1. Hwang, Jessica P., et al. “Hepatitis B Virus Screening for Patients With Cancer Before Therapy: American Society of Clinical Oncology Provisional Clinical Opinion Update.” Journal of Clinical Oncology. doi: 10.1200/JCO.2015.61.3745. [epub ahead of print]. May 11, 2015.