In a patient with negative Hep B surface Ag, Hep B surface antibody+, and Hep B core antibody+ serologies, do you initiate antiviral prophylaxis (e.g. entecavir) prior to starting rituximab?  

I would use entecavir for Hep B reactivation prophylaxis in this case - based on recommendations from AGA 2025 guidelines, which does classify b-cell depleting agents as higher risk for reactivation for both Hep B surface Ag-positive and Hep B surface Antigen neg/core positive patients. It should be...

I would also just ensure that the patient had not received IVIG over the preceding weeks leading up to Hep B core antibody testing, as the positivity could represent passive transfer of antibody and not a true history of infection. We have had a number of these cases during my fellowship. Lu et al.,...

Yes. Use either entecavir or tenofovir and continue for 12 months post rituximab.

No

Yes: would initiate preemptive treatment. We have seen patients where initiation of B-cell depleting treatment, such as rituximab or meds to prevent rejection in transplant patients, such as belatacept, has led to reactivation of hepatitis B.