A 35-year-old with chronic hepatitis B (HBeAg positive, HBV DNA 8 log IU/mL, ALT 3× ULN) needs antiviral therapy. He is planning fatherhood. The preferred first-line antiviral with the highest barrier to resistance is:
- A Lamivudine
- B Entecavir ✓
- C Adefovir
- D Telbivudine
Correct answer: B. Entecavir
Explanation
Entecavir (ETV) or tenofovir disoproxil fumarate (TDF)/tenofovir alafenamide (TAF) are the preferred first-line agents for chronic hepatitis B due to their high genetic barrier to resistance (multiple mutations required). Lamivudine has a very high resistance rate (~70% at 5 years). Adefovir has a higher resistance rate than entecavir and slower viral suppression. Telbivudine has resistance issues too. For a male patient planning fatherhood, entecavir is safe; tenofovir is preferred in co-infection with HIV.
Reference: Ananthanarayan & Paniker's Textbook of Microbiology, 11th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.