Choosing an Antiviral Agent for Initial Treatment of Hepatitis B Virus Infection

You answered:

A Lamivudine (Epivir-HBV) would be the preferred choice of therapy in this patient given its good safety profile and superior efficacy in patients with advanced liver disease.

This answer is incorrect. Lamivudine, while it has been shown to be safe in patients with cirrhosis, is not the preferred choice for initial therapy in any patient with chronic hepatitis B when long-term treatment is anticipated (as in this patient) given the high rates of cumulative resistance observed with this agent and reduced efficacy in head-to-head comparisons with newer agents.

Choose another answer:

B Adefovir (Hepsera) would be the preferred choice of therapy in this patient given its high potency.
C Peginterferon alfa-2a (Pegasys) should be used with caution in this patient given the possibility of hepatic decompensation with an immune-mediated flare during therapy.
D Initial combination therapy with three nucleos(t)ide analogue agents provides superior serologic and clinical outcomes when compared with monotherapy and thus triple nucleoside therapy would be the preferred treatment for this patient.

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