A 52-year-old man with chronic hepatitis B (HBeAg negative, HBV DNA 32,000 IU/mL, ALT 3× ULN, METAVIR F3) is assessed for therapy. Which first-line antiviral is preferred per EASL 2017 and APASL 2023 guidelines?
- A Tenofovir alafenamide (TAF) or tenofovir disoproxil fumarate (TDF) as first-line nucleos(t)ide analogues with high barrier to resistance ✓
- B Lamivudine as it is the oldest and cheapest nucleoside analogue
- C Pegylated interferon alfa-2a for finite 48-week course to achieve HBsAg seroconversion
- D Entecavir reserved for lamivudine-experienced patients
Correct answer: A. Tenofovir alafenamide (TAF) or tenofovir disoproxil fumarate (TDF) as first-line nucleos(t)ide analogues with high barrier to resistance
Explanation
Current EASL and APASL guidelines recommend entecavir, tenofovir disoproxil fumarate (TDF), or tenofovir alafenamide (TAF) as preferred first-line therapy due to their high barrier to resistance. TAF is preferred over TDF in patients with osteoporosis or renal impairment because of its superior renal and bone safety profile. Lamivudine and telbivudine have low barriers to resistance with high rates of mutations over 5 years. Peg-IFN is considered for young patients without cirrhosis seeking finite therapy but is less effective in HBeAg-negative disease.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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