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HBV Reactivation from Treatment Cessation — SCE Infectious Diseases MCQ

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ModerateHepatitisHBV Reactivation from Treatment CessationSCE Infectious Diseases

A 65-year-old man with known chronic hepatitis B develops acute deterioration with markedly elevated HBV DNA (from undetectable to 10⁸ IU/mL), ALT 3,500 U/L, and jaundice. He stopped Tenofovir DF 3 months ago because of perceived renal concerns (eGFR was 72 and stable). He was not co-infected with HIV. What is the management priority?

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Correct answer: D — Restart antiviral therapy urgently (Tenofovir or Entecavir) — this is an HBV reactivation flare from treatment cessation

This is a classic HBV reactivation flare caused by cessation of nucleos(t)ide analogue therapy. Stopping Tenofovir in an HBsAg-positive patient (without documented HBsAg loss) allows unchecked viral rebound, followed by immune-mediated hepatic destruction as the immune system recognises the newly-replicated virus. This can be fatal. Urgent restart of antiviral therapy (Tenofovir or Entecavir) is the priority. Interferon is contraindicated in decompensated liver disease. The original eGFR of 72 did not warrant stopping Tenofovir — the decision was premature.

Reference: NICE CG165 2013 – Hepatitis B; EASL 2024 – HBV guidelines