A 32-year-old man from Delhi presents with acute hepatitis B infection confirmed by HBsAg and HBeAg positivity. He has no evidence of cirrhosis or hepatic decompensation. What is the drug of choice for treatment of acute hepatitis B?

Question

Accepted Answer

C. Supportive care alone. ## Management of Acute Hepatitis B

**Key Point:** Acute hepatitis B infection in immunocompetent adults is typically self-limiting and does NOT require antiviral therapy. Supportive care is the standard approach.

### Rationale for Supportive Care

1. **Natural history**: 90–95% of immunocompetent adults spontaneously clear acute HBV infection within 6 months
2. **Fulminant hepatic failure risk**: Only 0.5–1% of immunocompetent adults develop fulminant hepatic failure; antiviral therapy does not reduce this risk in acute infection
3. **No evidence of benefit**: Antivirals are NOT indicated in acute HBV unless there is evidence of acute liver failure or prolonged cholestasis

### When Antivirals ARE Indicated

| Scenario | Drug of Choice |
|---|---|
| **Chronic HBV** (HBsAg+ >6 months) | Tenofovir or Entecavir |
| **Acute HBV with fulminant failure** | Lamivudine or Tenofovir (supportive care primary) |
| **Immunosuppressed with acute HBV** | Consider antiviral therapy |

**High-Yield:** Acute hepatitis B ≠ Chronic hepatitis B. Acute infection requires *observation*, not antivirals.

**Clinical Pearl:** Monitor for signs of fulminant hepatic failure (INR >1.5, encephalopathy, hypoglycaemia). If fulminant failure develops, antiviral therapy + ICU support + transplant evaluation are indicated.

### Why Other Options Are Wrong

- **Lamivudine, Tenofovir**: Reserved for chronic HBV or acute fulminant failure, not uncomplicated acute infection
- **Interferon-alpha**: Historically used; now rarely used due to poor efficacy in acute HBV and significant side effects

[cite:Harrison 21e Ch 297]

Answer

A. Lamivudine

Answer

B. Tenofovir

Answer

D. Interferon-alpha

A 32-year-old man from Delhi presents with acute hepatitis B infection confirmed by HBsAg and HBeAg positivity. He has no evidence of cirrhosis or hepatic decompensation. What is the drug of choice for treatment of acute hepatitis B?

Explanation

Management of Acute Hepatitis B

Rationale for Supportive Care

When Antivirals ARE Indicated

Why Other Options Are Wrong

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Scenario	Drug of Choice
Chronic HBV (HBsAg+ >6 months)	Tenofovir or Entecavir
Acute HBV with fulminant failure	Lamivudine or Tenofovir (supportive care primary)
Immunosuppressed with acute HBV	Consider antiviral therapy