A pregnant woman at 12 weeks gestation is found to have HBsAg positive, HBeAg positive, and HBV DNA of 2 × 10^8 IU/mL. To prevent mother-to-child transmission (MTCT), the recommended antiviral strategy in addition to neonatal HBIg and hepatitis B vaccine at birth is:

• A Interferon alfa from 28 weeks gestation to reduce viral load
• B Tenofovir disoproxil fumarate (TDF) from 28 weeks gestation onwards ✓
• C Lamivudine from 12 weeks gestation to delivery
• D No additional antiviral needed — HBIg + vaccine is sufficient regardless of viral load

Explanation

In highly viraemic mothers (HBV DNA >200,000 IU/mL or HBeAg positive with high viral load), neonatal immunoprophylaxis alone (HBIg + vaccine) reduces MTCT by ~95% but may fail in 5–10% of cases. WHO and APASL guidelines recommend adding tenofovir disoproxil fumarate (TDF) from 28 weeks of gestation to reduce maternal viral load at delivery, further reducing MTCT risk. TDF is preferred over lamivudine due to lower resistance rates and is safe in pregnancy. Interferon alfa is contraindicated in pregnancy.

Reference: Ananthanarayan & Paniker's Textbook of Microbiology, 11th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.