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: Separate the two problems.
The patient has two viral infections, hepatitis B (HBsAg positive) and hepatitis C, but also carries a transplanted kidney that depends on suppressed immunity to survive. The safest antiviral choice for the transplant has to come first.

Step 2: Think about what interferon does to the immune system.
Interferon amplifies immune activity, which is exactly what a transplant recipient does not want, since the immune system is being deliberately held back to protect the graft. Using interferon can wake up the immune response enough to attack the transplanted kidney. That single fact removes any option built around interferon.

Step 3: Weigh ribavirin on its own.
Ribavirin alone is a weak strategy against hepatitis C, it is normally paired with another drug, and by itself does nothing for the hepatitis B infection this patient also has.

Step 4: Look at what lamivudine offers.
Lamivudine works by directly inhibiting the polymerase enzyme of hepatitis B virus. It does not rely on ramping up the immune system, so it can be used safely in someone on immunosuppressive therapy after transplant.

Step 5: Conclude.
Given the need to protect the graft while still treating the hepatitis B infection, lamivudine alone is the most sensible and beneficial option here. In current practice, entecavir or tenofovir would usually be preferred over lamivudine for a better resistance profile, but among the listed choices lamivudine alone remains correct.
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