Re-emergence of hepatitis B virus (HBV) in patients who previously cleared the infection is most often described in immunocompromised individuals. High risk immunosuppressive therapies including anthracycline derivatives like doxorubicin may result in reverse seroconversion in more than 10% of patients and may require antiviral prophylaxis.1 In contrast, prophylaxis is not recommended for patients receiving low risk agents including azathioprine and low dose corticosteroids as the incidence of reverse seroconversion is <1%.