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

Authors: H. Nina Kim, MD, MSc Chloe L. Thio, MD

Last updated: January 25, 2010

A 45-year-old Cambodian man with HBeAg-negative chronic hepatitis B presents for evaluation. He has had serum alanine aminotransferase (ALT) levels of 60-80 U/L and HBV DNA level of 30,000 IU/mL. He has no history of ascites or encephalopathy and laboratory studies are unremarkable, including a normal serum albumin and total bilirubin level. An abdominal ultrasound shows a nodular liver without signs of portal hypertension, findings consistent with compensated cirrhosis. He has never received therapy for hepatitis B.

Which of the following statements is TRUE regarding the choice of available therapeutic agents for patients with chronic hepatitis B infection?

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.
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.