Deciding to Initiate Antiviral Treatment in Patients with Chronic Hepatitis B Virus Infection

You answered:

D The patient should not be treated for hepatitis B, but should be periodically tested for spontaneous HBeAg seroconversion (loss of HBeAg and development of anti-HBe).

This answer is incorrect. Seroconversion from HBeAg positive to HBeAg negative occurs at a rate of 8 to 12% yearly and is frequently associated with elevations in serum liver enzymes. This patient, however, has documented liver enzyme elevation for 6 months, and is still positive for HBeAg, suggesting he is unlikely to undergo spontaneous HBeAg seroconversion.

Choose another answer:

A Current treatment guidelines suggest that treatment is indicated for this patient.
B Liver biopsy is necessary before making a decision about initiating treatment
C If the patient has compensated cirrhosis, antiviral treatment would not be indicated because it could precipitate hepatic decompensation.

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