What is the standard long-term pharmacologic treatment for chronic hepatitis B?

• A. Interferon alfa
• B. Nucleos(t)ide analogs
• C. Ribavirin
• D. No pharmacologic therapy

Answer: (B)

Long-term suppression of HBV replication with nucleos(t)ide analogs is the standard pharmacologic approach for chronic hepatitis B. These drugs block viral DNA polymerase, leading to a sustained drop in HBV DNA, normalization of liver enzymes, and reduced risk of progression to cirrhosis and hepatocellular carcinoma. Entecavir and tenofovir are preferred first-line options because they are highly potent and have a high barrier to resistance, are well tolerated, and are suitable for long-term use often as ongoing or indefinite therapy to maintain viral suppression. Interferon alfa is given for a finite duration and has variable response rates with more side effects, making it less suitable for long-term management in most patients with chronic infection. Ribavirin alone does not effectively treat HBV, so it isn’t used as standard therapy for chronic hepatitis B. In practice, stopping therapy can lead to relapse, so continuing suppression is usually necessary to prevent disease progression.