What kind of monitoring do you choose in patients at risk for reactivation of hepatitis B who are on immunosuppression?

For patients at high risk of reactivation, I initiate prophylaxis and, given high efficacy, I don’t routinely monitor (other than to schedule annual appointments to make sure patients are getting refills). Generally, these patients are getting routine labs done by their oncologist or rheumatologist.

In low-risk scenarios where prophylaxis may be optional, monitoring ALT and HBV DNA every six months is reasonable.