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Primary Syphilis — RACP Adult Medicine MCQ

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HardInfectious DiseasesPrimary SyphilisRACP Adult Medicine

A 59-year-old with HBV-related compensated cirrhosis has undetectable HBV DNA on tenofovir and normal ALT for four years. HBsAg remains positive. He asks to stop therapy because viral replication is suppressed. What is the best advice?

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Correct answer: C — Continue tenofovir and maintain six-monthly cirrhosis-based HCC surveillance

The best answer is “Continue tenofovir and maintain six-monthly cirrhosis-based HCC surveillance”. In hepatitis-B cirrhosis, viral suppression is not cure, so stopping or reducing tenofovir risks virological flare. Pegylated interferon is not an appropriate finite substitute in this setting, and ultrasound/AFP surveillance does not replace antiviral therapy. Surveillance remains necessary because cirrhosis-associated hepatocellular-carcinoma risk persists despite undetectable HBV DNA.

Reference: ASHM, Treatment of chronic hepatitis B virus infection: https://testingportal.ashm.org.au/treatment-of-chronic-hepatitis-b-virus-infection/