A 35-year-old man with chronic hepatitis B (HBeAg positive) has HBV DNA 850,000 IU/mL, ALT 2.5× upper limit of normal, and liver biopsy showing moderate inflammation (METAVIR A2, F2). According to major guidelines, which is the most appropriate management?
- A Start entecavir or tenofovir, given significant histology and viremia ✓
- B Observe and monitor, as treatment is not indicated at this ALT level
- C Administer a 48-week course of pegylated interferon alfa only
- D Perform repeat biopsy in 6 months before any decision
Correct answer: A. Start entecavir or tenofovir, given significant histology and viremia
Explanation
Treatment is indicated in HBeAg-positive chronic hepatitis A when HBV DNA exceeds 20,000 IU/mL and ALT is >2× ULN with moderate-to-severe necroinflammation or fibrosis (≥F2). Entecavir or tenofovir are first-line oral antivirals. Option B is wrong because ALT >2× ULN with significant histology mandates therapy. Interferon is not preferred over potent oral agents in this setting. Delaying therapy risks progression.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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Written and medically reviewed by the StethoPrep medical team.