Clinical Impact of Routine HBV Screening in Oncologic Patients Prior to Chemotherapy

Background: Hepatitis B virus (HBV) reactivation in oncology patients receiving chemotherapy can cause severe hepatitis, including hepatic failure and death. Universal HBV screening before chemotherapy initiation can reduce HBV-related morbidity; however, screening practices vary widely, and guideline recommendations continue to evolve. Objective: The aim of this study was to evaluate the implementation of universal HBV screening in oncology patients and its effectiveness in identifying active infection, prior exposure, and individuals at risk for HBV reactivation. Methods: We implemented universal HBV screening at Rambam Health Care Campus in January 2018 for all patients initiating chemotherapy. This retrospective cohort study analyzed 1614 oncology patients who underwent chemotherapy between January 2018 and April 2024. Screening included testing for HBsAg, anti-HBc, and anti-HBs serology. HBV DNA testing was performed in patients with positive HBsAg and/or anti-HBc serology. Patients with known HBsAg positivity or those already receiving antiviral therapy were excluded. Results: Of the screened patients, 16 (1.0%) were HBsAg-positive, and 134 (8.3%) were HBsAg-negative/anti-HBc-positive. Detectable HBV DNA was identified in four patients (3%) within the latter group. One additional patient was classified as high risk for HBV reactivation based on the planned chemotherapy regimen. Overall, 21 patients met criteria for prophylactic antiviral therapy; however, prophylaxis was administered to only 17 patients. Notably, when applying the 2015 ASCO guidelines, only a single patient within the subgroup of HBsAg-negative, anti-HBc-positive, and HBV DNA-negative patients would have qualified for HBV serologic screening based on chemotherapy-related risk alone. Conclusions: Universal HBV screening prior to chemotherapy enables the identification of patients with active or prior HBV infection who would not have been detected using risk-based screening strategies alone. Our findings further support the implementation of universal HBV screening in oncology settings to prevent HBV reactivation and its potentially severe consequences.