Adult Gastroenterology Fellowship

Practice session

A 42-year-old man is evaluated during a routine health maintenance examination. He is asymptomatic. Laboratory testing reveals: HBsAg positive, HBeAg negative, anti-HBe positive, HBV DNA 45,000 IU/mL, serum ALT 98 U/L (reference: up to 35 U/L), and serum AST 76 U/L. Transient elastography demonstrates a liver stiffness measurement of 9.2 kPa (consistent with F2-F3 fibrosis). Abdominal ultrasound shows a normal-appearing liver without focal lesions. Which of the following is the most appropriate next step in management?

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