A 62-year-old man with cirrhosis (Child-Pugh B) from chronic hepatitis B is started on tenofovir disoproxil fumarate. At 48 weeks, his HBV DNA is undetectable, ALT is normal, and HBsAg remains positive. Which is the correct management?

• A Stop treatment since virologic response is achieved
• B Switch to pegylated interferon for 48 weeks
• C Continue tenofovir indefinitely ✓
• D Add pegylated interferon for 12 weeks then stop both

Explanation

In cirrhotic patients with chronic hepatitis C (compensated or decompensated), nucleos(t)ide analogs (tenofovir or entecavir) must be continued indefinitely regardless of virologic response, because discontinuation risks severe hepatic flare and decompensation. Stopping therapy is only considered in non-cirrhotic HBeAg-positive patients who achieve HBeAg seroconversion and complete 12 months of consolidation, or in HBeAg-negative patients after confirmed HBsAg loss. This is a critical exam distinction.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

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