MCQ – 90847

Correct Answer » A Explanation

This patient has features of immune-active chronic hepatitis B:

• HBeAg positive → active HBV replication.
• HBV DNA ~105 copies/mL → significant viral replication.
• Doubling of ALT/SGPT → active hepatocellular inflammation.
• Therefore, antiviral therapy is indicated.

Among the options, tenofovir is the preferred high-potency, high genetic-barrier nucleos(t)ide analogue. Treatment is generally long-term, rather than being limited to a short 6-month course.

The supplied All Subject material itself lists Entecavir and Tenofovir as oral first-line agents for chronic HBV.

It also specifically states that interferons are no longer used in its treatment section and that nucleos(t)ide analogues can be used instead.

Why the other options are incorrect

B. Lamivudine + Tenofovir — Incorrect

• Combination therapy is not routinely required when an effective, high-barrier agent such as tenofovir can be used.
• Lamivudine has a low genetic barrier to resistance, with the classic YMDD mutation causing resistance.

C. Pegylated interferon + Tenofovir for 6 months — Incorrect

• Pegylated interferon is not the preferred option here.
• The supplied material specifically notes that interferons are no longer used and identifies nucleos(t)ide analogues as appropriate alternatives.
• Six months is also not an appropriate fixed duration for tenofovir therapy.

D. Pegylated interferon + Lamivudine for 48 weeks — Incorrect

• This is the important trap in this MCQ.
• One section of the older High Yield PDFs says “Treatment of Choice for Hepatitis B – Interferon α + Lamivudine” and says interferon is recommended with increased HBV DNA and ALT.
• However, another portion of the supplied material explicitly gives the more updated framework: “Interferons are no longer used” and lists oral nucleos(t)ide analogues, particularly tenofovir/entecavir, as first-line therapy.