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

You answered:

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.

This answer is incorrect. Combination therapy with two or three oral agents has not been shown to improve serologic, biochemical, or histologic outcomes over single-agent therapy in patients with chronic hepatitis B. logic tests should first be performed to better characterize the stage of hepatitis B infection.

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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.
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.

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