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Altitude adaptation — MRCP Part 1 MCQ

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HardExercise PhysiologyAltitude adaptationMRCP Part 1

A 52-year-old with chronic hepatitis B has compensated cirrhosis on elastography and imaging. HBV DNA is detectable at 680 IU/mL on repeat testing, but ALT is normal. What antiviral approach follows NICE?

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Correct answer: B — Offer nucleos(t)ide analogue treatment despite normal ALT

The best answer is “Offer nucleos(t)ide analogue treatment despite normal ALT”. Cirrhosis changes the treatment threshold. NICE offers antiviral therapy to adults with compensated cirrhosis and detectable HBV DNA irrespective of ALT, because even low-level replication promotes decompensation and hepatocellular carcinoma. The higher viral-load and ALT thresholds help stratify non-cirrhotic disease and must not be applied to established cirrhosis.

Reference: NICE CG165, Hepatitis B (chronic): diagnosis and management: https://www.nice.org.uk/guidance/cg165/chapter/Recommendations