Female,  56 y old, who started last week chemotherapy following breast cancer. She is positive to HBsAg . She approached me after she had read this article: Hepatitis B Virus Reactivation in Breast Cancer Patients Undergoing Chemotherapy,  J Viral Hepat. 2017;24(7):561-572 which recommends on "Prophylactic nucleos(t)ide analogues (NAs) are recommended for patients with breast cancer who are hepatitis B surface antigen (HBsAg) positive before chemotherapy" . Since she didn't get Lamivudine before the starting chemo the first question is if it is worthwhile to  start now, 5 days after the initiation of the chemo ? The second questions is since we know she has slight fructose intolerance (which is one of the warning in the drug lable) – should she use this drug ? if yes, is there a way to decrease risk for adverse events ? if no – is there another prophylactic option ?

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