Hepatitis B screening before rituximab therapy: a multicentre South Australian study of adherence

Samuel A L Hall, Abdul Shaikh, Kailin Teh, Mahsa Tantingco, Douglas Coghlan, Christos S Karapetis, Mohamed A Chinnaratha, Richard Woodman, Kate R Muller, Alan J Wigg

Research output: Contribution to journalArticlepeer-review

4 Citations (Scopus)


Background: International guidelines recommend screening for hepatitis B virus (HBV) infection prior to administration of rituximab, due to high risk of HBV reactivation in at-risk patients. Aims: To determine: (i) adherence to the South Australian (SA) protocol for HBV screening; (ii) HBV prevalence in patients receiving rituximab; and (iii) outcomes of patients at risk of HBV reactivation. Methods: All patients commenced on rituximab at the six major SA public hospitals during a 12-month period were included in the study. Adherence was assessed by documentation of both hepatitis B surface antigen (HBsAg) and hepatitis B core antibody (HBcAb) prior to initiation of rituximab. Patients were observed for a minimum of 6 months following rituximab initiation. Results: Four hundred and thirty eight patients were included in the study. The main indication for rituximab therapy was haematological malignancy (76.0%). Two hundred and nine (47.7%) failed to receive appropriate HBV screening, 86 (19.6%) had neither HBsAg nor HBcAb performed, and 119 (27.2%) had only HBsAg performed. The identified prevalence of at-risk cases (either HBsAg- or HBcAb-positive) within the study population was 4.6% (20/438 cases). One case of HBV reactivation was identified, but none led to acute liver failure, transplantation or death. Conclusions: Poor adherence to HBV screening protocols suggests the need for targeted clinician education and system redesign. While the rate of reactivation was low, the prevalence of at-risk patients in this population was high and justifies further initiatives to increase adherence rates to HBV screening pre-rituximab.

Original languageEnglish
Pages (from-to)936-943
Number of pages8
JournalInternal Medicine Journal
Issue number8
Publication statusPublished - Aug 2018


  • rituximab
  • Hepatitis B
  • immunosuppression
  • lymphoma
  • entecavir
  • hepatitis B


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