AASLD guidelines: recommendations for treatment of hepatitis B carriers who require immunosuppressive or cytotoxic therapy [9].
AASLD guidelines 2009
Strength of recommendation
HBsAg and anti-HBc testing should be performed in patients who are at high risk of HBV infection, prior to initiation of chemotherapy or immunosuppressive therapy.
II-3
Prophylactic antiviral therapy is recommended for HBV carriers at the onset of cancer chemotherapy or of a finite course of immunosuppressive therapy.
(a) Patients with baseline HBV DNA<2,000 IU/mL level should continue treatment for 6 months after completion of chemotherapy or immunosuppressive therapy.
III
(b) Patients with high baseline HBV DNA (>2,000 IU/mL) level should continue treatment until they reach treatment endpoints as in immunocompetent patients.
III
(c) Lamivudine or telbivudine can be used if the anticipated duration of treatment is short (<12 months) and baseline serum HBV DNA is not detectable.
(I for lamivudine and III for telbivudine)
(d) Tenofovir or entecavir is preferred if longer duration of treatment is anticipated.
III
(e) IFN should be avoided in view of the bone marrow suppressive effect.
II-3
Quality of evidence on which a recommendation is based: I: randomized controlled trials, II-1: controlled trials without randomization, II-2: cohort or case-control analytic studies, II-3: multiple time series, dramatic uncontrolled experiments, and III: opinions of respected authorities and descriptive epidemiology.
