exam 4 - viral hepatitis Flashcards
what are the modes of transmission of hepatitis
fecal-oral
blood
sexual
what are the risk factors of hepatitis
A - direct contact
B - born to mother
C - injection drug use
prevention of hepatitis
vaccine
what forms of hepatitis have the potential for chronic infection
Hep B and Hep C
what does an all neg test for hep b mean
susceptible, never infected
what does
HBsAg: neg
anti-HBs: pos
anti-HBc: pos
resolved infection
what does
HBsAg: neg
anti-HBs: pos
anti-HBc: neg
immune from prior vaccine
what does
HBsAg: pos
anti-HBs: neg
anti-HBc: pos
IgM anti-HBc: pos
acute infection
what does
HBsAg: pos
anti-HBs: neg
anti-HBc: pos
IgM anti-HBc: neg
chronic infection
what does
HBsAg: neg
anti-HBs: neg
anti-HBc: pos
unclear result; either resolved, false positive, occult infx, infx w/ mutant strain
goals of chronic hep b management
achieve suppression
remission of liver disease
prevent liver complications
functional or virologic cure
what are the fundamental principles of hep b treatment
HBV DNA < 2000
indefinite duration of nucleoside analog therapy
(e- indef; e+ at least 12 months)
goals of therapy for hep c
obtain virologic cure
prevent complications & death
fundamental principles of hep c treatment
-all oral regimens
-combo prevents drug resistance
-treatment recommended for all chronic HCV
-DAAs for outpatient (risk of hepb activation)
what is the upper limit of normal for ALT for females
25 U/L
what is the upper limit of normal for ALT for males
35 U/L
classify:
normal ALT
elevated HBV DNA (++++)
e+ immune tolerant
classify:
normal ALT
low/undetectable HBV DNA (+/-)
e- inactive (carrier)
classify:
elevated ALT
elevated HBV DNA (+++)
e+ immune active or e- immune reactivation
what are the first line NAs for hepB
Tenofovir
Tenofovir alafenamide
entecavir
what are the first line cytokines for hepB
peginterferon alfa 2a
side effects of tenofovir alafenamide
lactic acidosis
monitoring of tenofovir alafenamide
LA levels
SCr
HIV
side effects of tenofovir
nephropathy
fanconi syndrome
osteomalacia
lactic acidosis
monitoring for tenofovir
CrCl at baseline
renal function
entecavir AEs
lactic acidosis
entecavir monitoring
LA levels
HIV status
peg-IFN-2a AEs
flu like
mood disturbance
autoimmune
anorexia
peg-IFN monitoring
CBC montly-3months
TSH
complications
for immune tolerant HBV patients what should be monitored
ALT q3-6 months and eAg q6-12 months
for e- inactive HBV, what should be monitored
ALT every 6-12 months
for patients on HBV therapy, what should be monitored
HBV DNA levels every 3 months
if therapy is stopped for HBV patients, what should be monitored
recurrent viremia, ALT flares, decompensation
for all HBsAg + patients with cirrhosis, what should be monitored
HCC surveillance every 6 months
what are the drug classes for HCV
NS3/4A protease inhibitors
NS5B polymerase inhibitors
NS5A replication complex inhibitors
what are the NS3/4A inhibitors
“previr”
peritaprevir
grazoprevir
glecaprevir
voxilaprevir
nsb5 inhibitors
“buvir”
sofosbuvir
dasabuvir
what are the NS5A inhibitors
“asvir”
ledipasvir
elbasvir
velpatasvir
pibrentasvir
what are the hepatitis guidelines
hcvguidelines.org
what is the pre-treatment testing for velpatasvir
NS5A genotype must be tested for the Y93H sub
what is the pre-treatment for elbasvir
NS5A genotype must be screened for RAS substitutions
what should be monitored for grazoprevir
ALT checked at 8 weeks
dc if >5xULN
