Hepatology International

, Volume 11, Issue 5, pp 429–433 | Cite as

Risk of hepatitis B reactivation in HBsAg-negative/HBcAb-positive patients with undetectable serum HBV DNA after treatment with rituximab for lymphoma: a meta-analysis

  • Zilin Tang
  • Xiaodong Li
  • Shunquan Wu
  • Yan Liu
  • Yan Qiao
  • Dongping XuEmail author
  • Jin LiEmail author
Original Article



Hepatitis B surface antigen (HBsAg)-negative/hepatitis B core antibody (HBcAb)-positive patients with undetectable serum hepatitis B virus (HBV) DNA have experienced and resolved hepatitis B virus (HBV) infection. Lymphoma patients with resolved HBV infection have high risk of HBV reactivation when treated with robust immunosuppressive agents, but the reported rate varies extensively between different studies. This study aims to estimate the risk of HBV reactivation in HBsAg-negative/HBcAb-positive patients receiving rituximab-containing chemotherapy for lymphoma.


Databases were searched for papers published in English until 8 August 2016. The pooled risk of HBV reactivation was estimated using a random-effects model.


Data from 15 studies were retrieved, including a total of 1312 HBsAg-negative/HBcAb-positive lymphoma patients treated with rituximab-containing chemotherapy. The results revealed HBV reactivation rate of 9.0 % [95 % confidence interval (CI) 0.05–0.15]. In subgroup analysis, the reactivation rates for prospective and retrospective studies were 17 % (I 2 = 87.3 %; 95 % 0.08–0.39, p < 0.001) and 7 % (I 2 = 43.1 %; 95 % CI 0.05–0.11, p = 0.07), respectively.


This meta-analysis confirms a measurable and potentially substantial risk of HBV reactivation in HBsAg-negative/HBcAb-positive patients with rituximab treatment for lymphoma. Prophylactic use of anti-HBV agents should be seriously considered for such patients.


Hepatitis B virus Rituximab Hepatitis B reactivation Lymphoma 



This work was supported by the National Natural Science Foundation (81373136, 81572010), Application Research of Capital Clinical Characteristic and Promotion of Achievements (Z151100004015011), and the Capital Health Development Research Special Independent Innovation Project (2016-2-5032).

Compliance with ethical standards

Conflict of interest

Zilin Tang, Xiaodong Li, Shunquan Wu, Yan Liu, Qiao Yan, Dongping Xu, and Jin Li declare that there are no conflicts of interest.

Human and animal rights statement

This study was approved by the ethics committee of Beijing 302 Hospital. This article does not contain any studies with human or animal subjects.


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Copyright information

© Asian Pacific Association for the Study of the Liver 2017

Authors and Affiliations

  1. 1.Clinical Medical SchoolGuilin Medical UniversityGuilinChina
  2. 2.Research Center for Clinical and Translational Medicine/Institute of Infectious DiseasesBeijing 302 HospitalBeijingChina

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