{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T11:38:13Z","timestamp":1785411493177,"version":"3.56.0"},"reference-count":25,"publisher":"MDPI AG","issue":"15","license":[{"start":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T00:00:00Z","timestamp":1784764800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"KAU Endowment (WAQF) at King Abdulaziz University"},{"id":[{"id":"https:\/\/ror.org\/02ma4wv74","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>Background\/Objectives: Hepatitis B virus (HBV) infection remains a major global health challenge because of its association with cirrhosis, hepatic failure, and hepatocellular carcinoma. Patients receiving rituximab-containing regimens are at particularly high risk for HBV reactivation due to profound B-cell depletion and prolonged immunosuppression. This study aimed to evaluate HBV serologic testing practices before rituximab initiation and to assess the incidence and outcomes of HBV reactivation among patients treated with rituximab at a tertiary care center in Jeddah, Saudi Arabia. Methods: A retrospective observational study was conducted on patients who received rituximab between 2010 and 2020 at a tertiary university hospital in Jeddah, Saudi Arabia. Demographic, clinical, laboratory, and treatment-related data were collected from electronic medical records. HBV reactivation was defined according to the American Association for the Study of Liver Diseases (AASLD) criteria. Results: A total of 611 patients were included. HBV serologic testing prior to rituximab initiation was documented in 60.8% of patients with hematological malignancies and 71.7% of those with non-hematological diseases. HBV reactivation occurred in 7 patients (3.4%) in the hematological malignancy cohort, all with lymphoma. Nine patients received antiviral prophylaxis. HBV reactivation was associated with significant morbidity, and liver-related mortality occurred in 28% of reactivation cases. Conclusions: HBV serologic testing was not universally documented prior to rituximab initiation, and antiviral prophylaxis was received by few patients. HBV reactivation was associated with significant morbidity and mortality. These findings support the need for systematic HBV evaluation and prophylaxis protocols in patients receiving rituximab.<\/jats:p>","DOI":"10.3390\/jcm15155762","type":"journal-article","created":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T09:11:26Z","timestamp":1784797886000},"page":"5762","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["HBV Serologic Testing Practices and Reactivation Outcomes Before Rituximab Initiation: A Retrospective Observational Study at an Academic Tertiary Care Centre"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2009-3817","authenticated-orcid":false,"given":"Ahmed S.","family":"Barefah","sequence":"first","affiliation":[{"name":"Hematology Department, Faculty of Medicine, King Abdulaziz University Hospital, King Abdulaziz University, Jeddah 21589, Saudi Arabia"},{"name":"Hematology Research Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah 21585, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1310-9868","authenticated-orcid":false,"given":"Omar M.","family":"Raslan","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, University of Jeddah, Jeddah 21493, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3961-0765","authenticated-orcid":false,"given":"Hatem M.","family":"Alahwal","sequence":"additional","affiliation":[{"name":"Hematology Department, Faculty of Medicine, King Abdulaziz University Hospital, King Abdulaziz University, Jeddah 21589, Saudi Arabia"},{"name":"Hematology Research Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah 21585, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3885-7782","authenticated-orcid":false,"given":"Eman M.","family":"Mansory","sequence":"additional","affiliation":[{"name":"Hematology Department, Faculty of Medicine, King Abdulaziz University Hospital, King Abdulaziz University, Jeddah 21589, Saudi Arabia"},{"name":"Hematology Research Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah 21585, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1578-3998","authenticated-orcid":false,"given":"Osman O.","family":"Radhwi","sequence":"additional","affiliation":[{"name":"Hematology Department, Faculty of Medicine, King Abdulaziz University Hospital, King Abdulaziz University, Jeddah 21589, Saudi Arabia"},{"name":"Hematology Research Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah 21585, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-2601-8389","authenticated-orcid":false,"given":"Esraa","family":"Almutairi","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Faculty of Medicine, King Abdulaziz University Hospital, King Abdulaziz University, Jeddah 21589, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-0762-6151","authenticated-orcid":false,"given":"Lujain","family":"Alsayegh","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Faculty of Medicine, King Abdulaziz University Hospital, King Abdulaziz University, Jeddah 21589, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lujain","family":"Alrabghi","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Faculty of Medicine, King Abdulaziz University Hospital, King Abdulaziz University, Jeddah 21589, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Basmah S.","family":"Almutairi","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Faculty of Medicine, King Abdulaziz University Hospital, King Abdulaziz University, Jeddah 21589, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2976-2696","authenticated-orcid":false,"given":"Mohammed A.","family":"Alsaadi","sequence":"additional","affiliation":[{"name":"Hematology Research Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah 21585, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5635-230X","authenticated-orcid":false,"given":"Salem M.","family":"Bahashwan","sequence":"additional","affiliation":[{"name":"Hematology Department, Faculty of Medicine, King Abdulaziz University Hospital, King Abdulaziz University, Jeddah 21589, Saudi Arabia"},{"name":"Hematology Research Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah 21585, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,23]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"12462","DOI":"10.3748\/wjg.v20.i35.12462","article-title":"Potential mechanisms of hepatitis B virus induced liver injury","volume":"20","author":"Suhail","year":"2014","journal-title":"World J. Gastroenterol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1118","DOI":"10.1056\/NEJMra031087","article-title":"Hepatitis B virus infection\u2014Natural history and clinical consequences","volume":"350","author":"Ganem","year":"2004","journal-title":"N. Engl. J. Med."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1155\/2005\/450574","article-title":"The laboratory diagnosis of hepatitis B virus","volume":"16","author":"Krajden","year":"2005","journal-title":"Can. J. Infect. Dis. Med. Microbiol."},{"key":"ref_4","unstructured":"World Health Organization (2024). Hepatitis B [Internet], WHO. Available online: https:\/\/www.who.int\/news-room\/factsheets\/detail\/hepatitis-b."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1715","DOI":"10.1016\/j.jiph.2020.09.004","article-title":"A tool to measure the economic impact of hepatitis B elimination: A case study in Saudi Arabia","volume":"13","author":"Sanai","year":"2020","journal-title":"J. Infect. Public Health"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1170","DOI":"10.1093\/annonc\/mdq583","article-title":"Rituximab-associated hepatitis B virus reactivation in lymphoproliferative diseases: Meta-analysis and examination of FDA safety reports","volume":"22","author":"Evens","year":"2011","journal-title":"Ann. Oncol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"299","DOI":"10.1002\/1096-9071(200011)62:3<299::AID-JMV1>3.0.CO;2-0","article-title":"Frequency of hepatitis B virus reactivation in cancer patients undergoing cytotoxic chemotherapy: A prospective study of 626 patients with identification of risk factors","volume":"62","author":"Yeo","year":"2000","journal-title":"J. Med. Virol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"162","DOI":"10.1002\/cld.883","article-title":"Reactivation of hepatitis B virus: A review of clinical guidelines","volume":"15","author":"Myint","year":"2020","journal-title":"Clin. Liver Dis."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"2232","DOI":"10.1007\/s12325-017-0612-x","article-title":"Rituximab in B-cell hematologic malignancies: A review of 20 years of clinical experience","volume":"34","author":"Salles","year":"2017","journal-title":"Adv. Ther."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"2572","DOI":"10.1056\/NEJMoa032534","article-title":"Efficacy of B-cell-targeted therapy with rituximab in patients with rheumatoid arthritis","volume":"350","author":"Edwards","year":"2004","journal-title":"N. Engl. J. Med."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"3228","DOI":"10.1182\/blood-2014-06-582346","article-title":"Safety and efficacy of rituximab in adult immune thrombocytopenia: Results from a prospective registry including 248 patients","volume":"124","author":"Khellaf","year":"2014","journal-title":"Blood"},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Castillo-Trivino, T., Braithwaite, D., Bacchetti, P., and Waubant, E. (2013). Rituximab in relapsing and progressive forms of multiple sclerosis: A systematic review. PLoS ONE, 8.","DOI":"10.1371\/journal.pone.0066308"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"447","DOI":"10.7326\/0003-4819-96-4-447","article-title":"Reactivation of chronic hepatitis B virus infection by cancer chemotherapy","volume":"96","author":"Hoofnagle","year":"1982","journal-title":"Ann. Intern. Med."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"2765","DOI":"10.1200\/JCO.2012.48.5938","article-title":"Randomized controlled trial of entecavir prophylaxis for rituximab-associated hepatitis B virus reactivation in patients with lymphoma and resolved hepatitis B","volume":"31","author":"Huang","year":"2013","journal-title":"J. Clin. Oncol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1111\/j.1365-2893.2007.00902.x","article-title":"Lamivudine prevents reactivation of hepatitis B and reduces mortality in immunosuppressed patients: Systematic review and meta-analysis","volume":"15","author":"Katz","year":"2008","journal-title":"J. Viral Hepat."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1111\/j.1478-3231.2007.01618.x","article-title":"Lamivudine prophylaxis is effective in reducing hepatitis B reactivation and reactivation-related mortality in chemotherapy patients: A meta-analysis","volume":"28","author":"Martyak","year":"2008","journal-title":"Liver Int."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"519","DOI":"10.7326\/0003-4819-148-7-200804010-00008","article-title":"Systematic review: The effect of preventive lamivudine on hepatitis B reactivation during chemotherapy","volume":"148","author":"Loomba","year":"2008","journal-title":"Ann. Intern. Med."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1560","DOI":"10.1002\/hep.29800","article-title":"Update on prevention, diagnosis, and treatment of chronic hepatitis B: AASLD 2018 hepatitis B guidance","volume":"67","author":"Terrault","year":"2018","journal-title":"Hepatology"},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"European Association for the Study of the Liver (2017). EASL 2017 clinical practice guidelines on the management of hepatitis B virus infection. J. Hepatol., 67, 370\u2013398.","DOI":"10.1016\/j.jhep.2017.03.021"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"3698","DOI":"10.1200\/JCO.20.01757","article-title":"Hepatitis B virus screening and management for patients with cancer prior to therapy: ASCO provisional clinical opinion update","volume":"38","author":"Hwang","year":"2020","journal-title":"J. Clin. Oncol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"219","DOI":"10.3350\/cmh.2016.0024","article-title":"Prevention of hepatitis B reactivation in the setting of immunosuppression","volume":"22","author":"Pattullo","year":"2016","journal-title":"Clin. Mol. Hepatol."},{"key":"ref_22","first-page":"27","article-title":"Negative effect of hepatitis in overall and progression-free survival among patients with diffuse large B-cell lymphoma","volume":"13","author":"Alghamdi","year":"2018","journal-title":"Infect. Agents Cancer."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"429","DOI":"10.1007\/s12072-017-9817-y","article-title":"Risk of hepatitis B reactivation in HBsAgnegative\/ HBcAb-positive patients with undetectable serum HBV DNA after treatment with rituximab for lymphoma: A meta-analysis","volume":"11","author":"Tang","year":"2017","journal-title":"Hepatol. Int."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"321","DOI":"10.1007\/s40264-024-01399-4","article-title":"Consensus guidelines: Best practices for the prevention, detection and management of hepatitis B virus reactivation in clinical trials with immunosuppressive\/immunomodulatory therapy","volume":"47","author":"Cohen","year":"2024","journal-title":"Drug Saf."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1518","DOI":"10.1016\/j.jiph.2023.07.008","article-title":"Hepatitis B virus infection in Saudi Arabia and the UAE: Public health challenges and their remedial measures","volume":"16","author":"Sanai","year":"2023","journal-title":"J. Infect. Public Health"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/15\/5762\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T09:45:27Z","timestamp":1784799927000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/15\/5762"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,23]]},"references-count":25,"journal-issue":{"issue":"15","published-online":{"date-parts":[[2026,8]]}},"alternative-id":["jcm15155762"],"URL":"https:\/\/doi.org\/10.3390\/jcm15155762","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,23]]}}}