Hepatitis B virus

Question: All of the following are true statements about the treatment of hepatitis B virus (HBV) except:

A. advanced fibrosis can be reversed by giving entecavir

B. the risk for cancer can be reduced

C. tenofovir and entecavir are associated with resistance rates of 5-10% in treatment-naive patients

D. interferon can be very useful

Answer: Treating HBV can be complicated, so let’s go through the nuts and bolts here.  Usually treatment will be offered when the ALT is elevated and the viral load is high.  When treatment is offered, one of the benefits is the reduced risk of hepatocellular carcinoma.  Also, there is now evidence that the use of entecavir is associated with a reduction in the stage of fibrosis in nearly 75% of patients.  That is exciting.

Tenofovir and entecavir are now first-line therapies and very potent drugs.  Fortunately, for treatment naive patients, the rate of drug resistance is very low, around 0-1% over 2 years.  Therefore answer choice C is the correct answer.

Although we commonly associate interferon use with hepatitis C virus (HCV), it is also used in some HBV settings.  Young, Asian males are sometimes responsive to this drug, and it has higher rates of HBsAg seroconversion compared to the nucleosides/tides.

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