American Board of Internal Medicine (ABIM) Certification Practice Exam

Under what circumstances is treatment recommended for patients with HBV?

1. Elevated ALT levels

2. History of liver cancer

3. Presence of cirrhosis only

4. Positive family history for hepatitis

The correct answer is: Elevated ALT levels

Treatment for patients with hepatitis B virus (HBV) infection is typically indicated under specific clinical circumstances, one of which is elevated alanine aminotransferase (ALT) levels. Elevated ALT levels serve as a marker of liver inflammation and activity, suggesting that the virus is actively replicating and potentially causing damage to liver tissues. When ALT levels are persistently elevated, it indicates the need for closer monitoring and potentially initiating antiviral therapy to decrease the risk of progressive liver disease, cirrhosis, or hepatocellular carcinoma. While a history of liver cancer, presence of cirrhosis, and a positive family history for hepatitis are important factors in the overall management of HBV, they do not independently dictate the initiation of treatment in the absence of additional clinical signs or symptoms. A history of liver cancer would generally lead to more aggressive surveillance rather than preventative treatment unless specific current risk factors are present. Similarly, treatment decisions in patients with cirrhosis are more complex and depend on various factors including the degree of liver function impairment. A positive family history indicates a potential risk of HBV-related complications but does not directly warrant treatment for the individual patient without evidence of active disease or liver damage. Thus, the recommendation for treatment is primarily based on