Routine testing of haematological malignancy patients for hepatitis B (HBV) before starting treatment is one of the key recommendations in new guidelines endorsed by the Haematology Society of Australia and New Zealand (HSANZ)

An Australian consensus statement has been developed with the aim of simplifying the approach to testing and prophylaxis for HBV during cancer therapy.

“Hepatitis B management during immunosuppression for haematological and solid-organ malignancies: An Australian consensus statement 2019″ has been developed by a committee including specialists in haematology and oncology as well as with infectious diseases, hepatology and paediatric specialists.

According to HSANZ, a simple and universal risk reduction approach is needed for cancer patients because about 240,000 Australians are living with HBV infection, and approximately 2.3 million Australians have been exposed or infected in the past.

“Individuals with current or previous hepatitis B are at risk of the virus reactivation during cancer therapy. Reactivation can lead to liver failure, death or cancer treatment interruption that reduces cancer survival. Given the number of people undergoing cancer therapy and the burden of hepatitis B in Australia, several thousand people are likely to be at risk of hepatitis B reactivation each year,” a statement from the guideline authors says.

One of the key recommendations is to ‘test all’ patients scheduled to undergo cancer treatment for hepatitis B to ensure that no cases of infection are missed and they are not put at risk, they said.

The guidelines steering committee was led by Dr Joseph Doyle from the Australasian Society for Infectious Diseases (ASID).

“Given this national approach is recommended for all cancer patients, we encourage the Pharmaceutical Benefits Scheme to subsidise the cost of hepatitis B antiviral agents during cancer therapy,” he said.

“The Medicare Benefits Schedule should include rebates for hepatitis B virus testing during and after cancer therapy, in accordance with these recommendations. We urge health care services and specialists to develop systems to implement these best practice recommendations.”

The consensus statement was produced by a partnership of the Haematology Society of Australia and New Zealand (HSANZ), the Medical Oncology Group of Australia (MOGA), the Australasian Society for Infectious Diseases (ASID), the Gastroenterological Society of Australia (GESA), and the Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine (ASHM).

The guideline recommendation include:

• All patients undergoing therapy for haematological malignancy are tested for HBV.
• The treating haematologist/medical oncologist prescribing cancer therapy is responsible for HBV testing HBsAg.
• Anti-HBc and anti-HBs are performed when testing for hepatitis B infection.
• All HBsAg positive patients undergoing cancer therapy should receive antiviral prophylaxis.
• Risk for HBV reactivation in patients who are HBsAg negative and anti-HBc positive should be determined by the cancer therapy regimen (higher risk vs lower risk).
• Antiviral prophylaxis should be commenced as soon as possible relative to the commencement of cancer therapy, but should not delay cancer therapy.

The guidelines also include recommendation on how to monitor individuals and when to stop antiviral agents.