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HBV Reactivation Prescribing Error — SCE Infectious Diseases MCQ

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EasyHepatitisHBV Reactivation Prescribing ErrorSCE Infectious Diseases

A 55-year-old man with chronic HBV on Entecavir has his treatment interrupted for 3 months by a prescribing error (repeat prescription was not issued). His HBV DNA rises to 4 × 10⁷ IU/mL and ALT increases to 1,200 U/L. He develops jaundice and coagulopathy (INR 2.1). What is the management priority?

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Correct answer: B — Restart Entecavir URGENTLY plus assess for liver transplant listing — this is an HBV reactivation flare from treatment interruption that can be fatal without prompt antiviral restart

This is a medical emergency: HBV reactivation from NUC cessation. Urgent management: (1) restart Entecavir (or Tenofovir) immediately, (2) supportive care for liver failure (coagulopathy management, glucose monitoring, infection prevention), (3) assess for liver transplant listing (King's College criteria if progressing to acute liver failure). The prescribing error causing treatment interruption is a systems failure — automated repeat prescriptions and patient education about never stopping NUCs without medical advice are essential preventive measures.

Reference: EASL 2024 – HBV; NICE CG165; BSG 2023