A 52-year-old man with known hepatitis B (HBsAg positive, HBeAg negative, HBV DNA 38,000 IU/mL, ALT 84 U/L, liver biopsy Metavir F2-F3) requires antiviral therapy. His wife is pregnant and will deliver in 8 weeks. Considering both indications, the preferred antiviral is:
- A Entecavir — most potent for the patient's chronic HBV; avoid in wife's perinatal prophylaxis
- B Pegylated interferon-alpha for the patient due to finite treatment duration; TDF for the wife
- C Tenofovir alafenamide (TAF) for the patient and tenofovir disoproxil fumarate (TDF) in the third trimester for the wife's perinatal prophylaxis ✓
- D Lamivudine for both, as it is the only agent safe in pregnancy and with the longest track record
Explanation
For chronic HBV with significant fibrosis (F2-F3), first-line antivirals are tenofovir (TDF or TAF) or entecavir. TAF has superior renal and bone safety profile making it preferred for long-term therapy. For the wife's perinatal prophylaxis to prevent mother-to-child transmission in third trimester (indicated when HBV DNA > 200,000 IU/mL), TDF has the most robust safety data in pregnancy (WHO 2022, AASLD, EASL). TAF safety data in pregnancy are still accruing. Pegylated interferon has a finite treatment but is contraindicated in decompensated cirrhosis and not indicated here given HBeAg-negative chronic HBV. Lamivudine has high resistance rates.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.