skip to main content

Chronic hepatitis B treatment threshold — USMLE Step 3 MCQ

Instant feedback + full explanation. One question, done properly.

HardInternal Medicine (chronic management)Chronic hepatitis B treatment thresholdUSMLE Step 3

A patient with HBeAg-negative chronic hepatitis B has HBV DNA 78,000 IU/mL, ALT 96 U/L on repeat testing and elastography consistent with advanced fibrosis. Creatinine is normal and there is no pregnancy. What is the most appropriate treatment?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: E — Begin tenofovir or entecavir with longitudinal surveillance

The best answer is “Begin tenofovir or entecavir with longitudinal surveillance”. Raised hepatitis B virus DNA, repeated alanine aminotransferase elevation, and advanced fibrosis indicate immune-active chronic hepatitis B requiring potent nucleos(t)ide analogue therapy. Tenofovir or entecavir are preferred first-line agents; ongoing surveillance is needed because fibrosis confers continued liver risk. Waiting for decompensation, prednisone, unnecessary biopsy, or hepatitis C antivirals would not treat the established hepatitis B indication.

Reference: AASLD, Chronic Hepatitis B Practice Guidance: https://www.aasld.org/practice-guidelines/chronic-hepatitis-b