Chronic HBV Treatment — RACP Adult Medicine MCQ

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EasyGastroenterologyChronic HBV TreatmentRACP Adult Medicine

A 40-year-old man with chronic HBV (HBeAg positive, HBV DNA 8×10⁶ IU/mL, ALT 150 U/L, no cirrhosis) meets treatment criteria. He wants the most convenient regimen. What is the most appropriate antiviral?

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Correct answer: E — Tenofovir disoproxil fumarate (TDF)

HBeAg-positive chronic HBV with elevated HBV DNA (>20000 IU/mL) and elevated ALT (>2× ULN) meets GESA treatment criteria. First-line nucleos(t)ide analogues: TDF or entecavir (both have high barrier to resistance). TAF is preferred over TDF in patients with renal/bone disease risk. Pegylated interferon (48-week course) offers the advantage of finite treatment duration and HBsAg loss in ~10% but has more side effects. NAs are typically lifelong unless HBsAg seroconversion occurs.

Reference: GESA – 2022 – Hepatitis B Treatment; AASLD 2024