Question

A 30-year-old male is found to be positive for HBsAg and HBeAg and is diagnosed with chronic hepatitis B. The patient’s viral load was 2x 100000 and SGPT is found to be doubled. What is the appropriate management in this patient? SGPT-Serum glutamate pyruvate transaminase

• A. Lamivudine for 30+ weeks
• B. Tenofovir for > 40 weeks
• C. Pegylated interferon for 52 weeks
• D. Combined pegylated interferon with lamivudine

Answer 1

The Correct Option is B

The management of chronic hepatitis B, particularly for patients who are positive for HBsAg and HBeAg with elevated viral load and SGPT, involves deciding on antiviral therapy that effectively reduces viral replication and prevents liver damage. For this 30-year-old male patient with a viral load of 200,000 and elevated SGPT, the appropriate management is crucial.

Rationale:

1. The patient is young, with active hepatitis indicated by positive HBeAg and elevated SGPT levels, suggesting liver inflammation.
2. Antiviral therapy is required to control the disease and prevent progression to cirrhosis or hepatocellular carcinoma.
3. Tenofovir is a potent antiviral medication with a high barrier to resistance and is recommended for treating chronic hepatitis B in patients with high viral loads.

Option Analysis:

Option	Explanation
Lamivudine for 30+ weeks	Lamivudine was an early treatment for hepatitis B but has a low resistance threshold and is not first-line.
Tenofovir for > 40 weeks	Tenofovir is effective, with a high barrier to resistance. It is appropriate for treating hepatitis B in this case.
Pegylated interferon for 52 weeks	Interferon therapy can be used but is less commonly recommended due to side effects and lower efficacy in HBeAg positive cases specifically with high viral load.
Combined pegylated interferon with lamivudine	This combination is generally not preferred due to potential for resistance and increased side effects.

Given the patient's clinical profile and the properties of Tenofovir, the most suitable option is:

Tenofovir for > 40 weeks