Patients with chronic hepatitis B are missing out on antiviral prophylaxis prior to initiation of biologic agents, putting them at risk of viral reactivation, Australian doctors warn. 

Results from their meta-analysis show the prevalence of reactivation after starting biologic therapy is up to nine times higher in chronic carriers of hepatitis B virus (HBV) compared to occult carriers.

Australian and international guidelines suggest that patients who are surface antigen-positive should receive entecavir or tenofovir prophylaxis before starting immunosuppressive or cytotoxic therapy.

But despite these recommendations, University of Sydney researchers say the uptake of prophylactic antiviral therapy in this setting remains low, even among high-risk patients.