Hep A & B

Question 1

Hep A Background

Answer 1

• Enveloped RNA virus
• Piornavirus
• Causes acute infection only
• Spread via fecal oral route
• Can survive outside the body for months

Question 2

Which antibodies are elevated in acute vs prior Hep A

Answer 2

-IgM = acute infection
(5 to 10 days)
-IgG = prior infection
(4 to 6mo)

Question 3

Seroconversion rates for vaccine

Answer 3

• 94% with first dose
• Booster is still recommended
• Most common vaccine preventable infection

Question 4

Why are Hep A rates highest in rural areas

Answer 4

-Lack of access

Question 5

How many shots are in the Hep A schedule?

Answer 5

• Havrix and VAQTA are both a 2 shot series (0 and 6-12mo)

- Twinrix (HAV/HAB) is a 3 shot series (0, 1, 6mo)

Question 6

Hep B background

Answer 6

• DNA virus that becomes a part of human DNA (cccDNA)
• Transmitted via percutaneous or mucosal contact with infected blood/ fluids
• Can live outside of the body for about 7 days

Question 7

Hep B surface antigen (HBsAg)

Answer 7

• Protein found on the surface of HBV

- Detectable (+) in acute and chronic infections

Question 8

Hep B surface antibody (anti-HBs)

Answer 8

• Will be (+) following successful vaccination series
• Antibody = made by us
• Antigen = made by virus

Question 9

Hep B core antibody (Anti-HBc)

Answer 9

• (+) result indicates prior or ongoing infection
• If positive Anti-HBc and positive HBsAg then there is an active infection
• IgM = active infection
• IgG = prior/ chronic infection

Question 10

Hep B vaccination

Answer 10

-3 dose series (0, 1, 6mo) 
30 to 50% with 1st dose 
75% with 2nd dose
96% with 3rd dose 
-Most patients do NOT finish series

Question 11

Heplisav B

Answer 11

• 2 doses (0 and 1mo)
• New adjuvant = more robust immune response
• Pts are more likely to finish series

Question 12

Immunoglobulins in Hep B

Answer 12

• Passive protection
• Used to prevent perinatal transmission
• Give w/in 24hrs of birth from HBV positive mother
• Not routinely used in adults

Question 13

When to treat Hep B

Answer 13

• HBV > 2000 IU/mL
• ALT levels > ULN
• Pts with cirrhosis (compensated or decompensated)

Question 14

Preferred treatments for Hep B

Answer 14

1) Entecavir- inhibits HBV polymerase
2) Tenofovir
TDF- requires renal adjustment
-Safe in pts with cirrhosis

Question 15

Why do we not use interferons anymore?

Answer 15

• Lots of side effects

- Risk of decompensation

Question 16

Non-preferred agents due to concerns for developing resistance

Answer 16

1) Adefovir
- Safe in cirrhosis
- Some activity against HIV
2) Lamivudine
- High rates of resistance by 5 years use of treatment
- Safe in cirrhosis and immunocompromised
3) Telbivudine
- Specific for HBV
- Safe in cirrhosis

Question 17

Management of Hep B in immunosuppressive therapies

Answer 17

• Should be tested for Hep B
• Vaccinate
• Check HBsAg and AntiHBc
• Start prophylaxis before immunosuppressive therapy
• Pts on immunosuppressive therapy are at risk for reactivation

Question 18

HBV and pregnancy

Answer 18

• High risk of transmission at delivery
• Risk is minimized by using tenofovir or lamivudine for mom
• Vaccinate and use immunoglobulin for active and passive protection for the new born

Question 19

HBV and HIV

Answer 19

• All patients should be tested for HIV
• Antivirals can be used in both HBV and HIV
• Ok to use monotherapy in HBV but NOT in HIV