Virology: chronic hepatitis E in transplant recipients: practice question

A Microbiology question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Microbiology · Virology: chronic hepatitis E in transplant recipients

Sample item

A kidney transplant recipient on tacrolimus has had raised transaminases for eight months. HEV RNA is repeatedly detected in serum, and hepatitis B and C tests are negative. What is the best initial management?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

C. Reduce immunosuppression, then consider ribavirin

Hepatitis E virus can become chronic in solid organ transplant recipients, with progression to cirrhosis. The first step is to reduce immunosuppression if possible, and persistent viraemia is treated with a course of ribavirin.

Option by option

  • A. Start entecavir for 48 weeks

    Entecavir is a hepatitis B polymerase inhibitor and has no role in HEV infection.

  • B. Start high-dose oral acyclovir

    Acyclovir acts on herpesviruses, not on the RNA virus HEV.

  • C. Reduce immunosuppression, then consider ribavirin (correct)

    Correct. Lowering immunosuppression allows clearance, and ribavirin is used if viraemia persists.

  • D. Give hepatitis E vaccine alone and observe

    Vaccination does not clear established chronic infection.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Microbiology question

What is the answer to this Microbiology question?

The best answer is C, Reduce immunosuppression, then consider ribavirin. Hepatitis E virus can become chronic in solid organ transplant recipients, with progression to cirrhosis.

Why is "Start entecavir for 48 weeks" not the answer?

Entecavir is a hepatitis B polymerase inhibitor and has no role in HEV infection.

Why is "Start high-dose oral acyclovir" not the answer?

Acyclovir acts on herpesviruses, not on the RNA virus HEV.

Why is "Give hepatitis E vaccine alone and observe" not the answer?

Vaccination does not clear established chronic infection.

What concept does this question test?

It tests Virology: chronic hepatitis E in transplant recipients in Microbiology. The first step is to reduce immunosuppression if possible, and persistent viraemia is treated with a course of ribavirin.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Virology: chronic hepatitis E in transplant recipients?

Make a one-line identity card for each organism: shape and stain, defining test, toxin, disease and drug. Then use the flashcards and the other Microbiology questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.