HBV DNA Testing for Patients with Past Hepatitis B Infection

Understanding the Serologic Profile

The serologic pattern of HBsAg negative, HBcAb positive, HBeAg negative is consistent with past or resolved HBV infection, where the virus has been cleared from serum but may persist as covalently closed circular DNA (cccDNA) in hepatocytes 1
This pattern indicates the patient has been exposed to HBV in the past and has developed an immune response 2

Patients with this serologic profile are at risk for HBV reactivation if they undergo immunosuppressive therapy 2, 3
The risk of reactivation varies from 3-45% in HBcAb-positive patients receiving immunosuppression 3
Planned chemotherapy or immunosuppressive therapy is a risk factor that warrants HBV DNA testing, according to the Journal of Clinical Oncology guidelines 4
Anti-CD20 therapy (rituximab) or stem cell transplantation is considered high-risk for HBV reactivation 4
Other immunosuppressive regimens, including high-dose corticosteroids, tyrosine kinase inhibitors, and anti-CD52 monoclonal antibodies, also increase the risk of reactivation 2

Routine HBV DNA testing is generally not necessary for patients with past infection who are not undergoing immunosuppression, as stated by the Clinical and Molecular Hepatology guidelines 5
The American Society of Clinical Oncology (ASCO) guidelines recommend HBV DNA testing before anticancer therapy in patients with evidence of HBV infection 4
If HBV DNA is detectable (viremic), patients should receive antiviral prophylaxis similar to HBsAg-positive patients, according to the Journal of the National Comprehensive Cancer Network guidelines 2, 3

For patients with past HBV infection not receiving immunosuppression, no specific monitoring for HBV DNA is recommended, and normal liver function tests suggest inactive disease 5, 6, 7
For patients with past HBV infection undergoing immunosuppression, monitoring of HBsAg and ALT every 3 months during anticancer therapy is recommended if not receiving antiviral prophylaxis 4
If receiving antiviral prophylaxis, checking HBV DNA and ALT at baseline and every 6 months during antiviral therapy is recommended 4
Continue monitoring for at least 12 months after completing immunosuppressive therapy, as suggested by the Clinical and Molecular Hepatology guidelines 5

Anti-HBs positivity (surface antibody) may provide some protection against reactivation, but does not completely eliminate the risk, according to the Clinical and Molecular Hepatology guidelines 1
False-negative HBsAg results can occur in patients with chronic liver disease, as noted by the Journal of the National Comprehensive Cancer Network guidelines 2