Chronic Hepatitis B — RACP Adult Medicine MCQ
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Correct answer: B — Commence entecavir with renal dose adjustment and continued virological and fibrosis monitoring
Explanation lettering: B = shown as A · E = shown as B · A = shown as E
E is correct. Treatment is indicated by active viral replication, elevated ALT and significant fibrosis. Entecavir and tenofovir are Australian first-line agents; in a treatment-naive patient with CKD and osteoporosis, renal-adjusted entecavir avoids the renal and bone disadvantages of tenofovir disoproxil fumarate. A, B and C have inferior resistance or toxicity profiles and are not preferred first-line options. D selects the tenofovir formulation least attractive for this comorbidity pattern; tenofovir alafenamide may be another specialist option where available and appropriate. Long-term adherence, HBV DNA response, renal function, fibrosis and hepatocellular-carcinoma surveillance remain necessary because viral suppression does not eliminate cancer risk.
Reference: ASHM: Treatment of chronic hepatitis B virus infection: https://testingportal.ashm.org.au/treatment-of-chronic-hepatitis-b-virus-infection/