Question

An individual who underwent renal transplantation one year ago is found positive for HBsAg and HCV. Treatment with which of the following will give this patient maximum benefit?

• A. Lamivudine and interferon (IFN)
• B. Lamivudine alone
• C. Ribavirin
• D. Interferon (IFN)

Hint:

Interferon is avoided after organ transplant because it can trigger rejection; lamivudine treats HBV without that risk.

Answer 1

The Correct Option is B

Step 1: Note the special situation, a transplant recipient.
This patient has a functioning kidney transplant, so they are on long term immunosuppressive drugs to prevent rejection. Any antiviral choice has to be safe in that setting, not just effective against the virus.

Step 2: Recall why interferon is avoided after transplant.
Interferon works partly by boosting the immune system's antiviral response. In a transplant recipient, stimulating the immune system this way can trigger acute graft rejection, so interferon (alone or combined with lamivudine) is generally avoided in solid organ transplant recipients. This rules out the two options that contain interferon.

Step 3: Recall why ribavirin alone is not the answer.
Ribavirin is used for hepatitis C, almost always combined with interferon or another agent, and ribavirin monotherapy is not an effective long term strategy on its own. It also does not address the HBsAg positive status here.

Step 4: Explain why lamivudine alone fits.
Lamivudine is a nucleoside analog that directly blocks the hepatitis B viral polymerase without needing to activate the immune system, so it does not carry the same rejection risk as interferon. This makes it the safer and more practical choice for treating chronic HBV in a transplant recipient.

Step 5: Final answer.
Among the given options, lamivudine alone gives the best benefit with the lowest rejection risk in this transplant patient. Current practice now generally favors newer nucleoside/nucleotide analogs such as entecavir or tenofovir over lamivudine because of lamivudine's higher rate of drug resistance with long term use, but the underlying principle, avoiding interferon after transplant, still holds.
\[ \boxed{\text{Lamivudine alone}} \]