American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the recommended treatment option for HBV patients with high ALT levels and low HBV DNA levels?

1. Pegylated interferon

2. Entecavir

3. Lamivudine

4. Sofosbuvir

The correct answer is: Pegylated interferon

The recommended treatment option for HBV patients with high ALT levels and low HBV DNA levels is pegylated interferon. This treatment is particularly well-suited for patients who exhibit elevated alanine aminotransferase (ALT) levels as it indicates active liver inflammation, while the lower levels of HBV DNA suggest a less active viral replication phase. Pegylated interferon therapy aims to boost the immune response against the virus, which can lead to an improvement in liver function tests and potentially a sustained virologic response. It is effective in inducing immune-mediated clearance of the virus in certain populations, particularly in older patients and those who do not have significant liver damage. Additionally, pegylated interferon is often considered when patients show signs of active disease with acceptable tolerability for a course of therapy lasting around 48 weeks. Other options such as entecavir and lamivudine are antiviral medications that are typically chosen for patients with high levels of HBV DNA, where immediate suppression of the virus is necessary. Sofosbuvir, on the other hand, is primarily used for Hepatitis C and is not indicated for Hepatitis B virus treatment. Therefore, pegylated interferon is the most appropriate choice given the described situation,