Hepatitis B

Question: All of the following can be used to treat Hepatitis B viral infection except:

A. entecavir

B. interferon

C. ribavirin

D. lamivudine

E. tenofovir

Answer: Hepatitis B virus does not always require treatment.  In patients with a wild type infection (surface antigen positive and e antigen positive) treatment is often initiated if ALT is elevated and the viral load is >20,000 IU/mL.  For those with a precore mutant (surface antigen positive and e antigen negative), treatment is often initiated if ALT is elevated and the viral load is >2,000 IU/mL.

Historically, lamivudine was regarded as first line of treatment; however, the high frequency of resistance to this drug has made it an unattractive first option.  Both entecavir and tenofovir are excellent choices for first line therapy.  Caution must be heeded before starting entecavir in patients who have previously been treated with lamivudine, as cross-resistant strains are not uncommon.  This is not the case with tenofovir.

Interferon is commonly thought of as the choice of therapy for hepatitis C, however, there are some cases where it is utilized successfully in hepatitis B infection.  It is the only option where hopes of seroconverting the surface antigen into surface antibody (a “cure”) are realistic.  This may be particularly true in young, asian males.  Ribavirin, on the other hand, is an antiviral therapy not used in hepatitis B virus infection.

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