HBV Flashcards
What type of virus is HBV?
Family: Hepadnaviridae
Genus: Orthohepadnavirus
Small (42nm), Enveloped, Partially dsDNA
What is 5Y cumulative incidence of cirrhosis in an untreated CHB pt?
8-20%.
Among those with cirrhosis; the 5Y risk of decompensation is 20%.
What is the annual risk of HCC in pts with cirrhosis?
2-5%
What are the host related risk factors for developing HCC in untreated CHB pt?
Chronic hepatitis necroinflamfmation/Cirrhosis
Co-infection with other hepatitis viruses or HIV
Male/older age/ African origin/FH of HCC
Alcohol abuse/Active smoking
DM/Metabolic syndrome
What are HBV properties that increase risk of HCC in untreated CHB pt?
High HBV DNA &/or
HBV genotype C > B*
Specific mutations
- C for cancer
What are the components of the initial assessment of pts with chronic HBV infection?
1)Complete history + physical examination
2)Assessment of liver disease activity and severity > identify pts for ttt and HCC surveillance.
-physical exam
-biochemical tests (AST/ALT/GGT/ALP/bilirubin/Albumin/gamma globulin/FBC/PT)
-liver USS
* if above inconclusive: liver biopsy or non-invasive (Elastography)
3)Assessment of markers of HBV infection.
-HBaAg and Anti-HBe
-HBV DNA serum level
-HBsAg quantification
4) Exclude other causes of CLD (AI/Metabolic/alcohol..)
5) Exclude co-infection with HDV/HCV/HIV.
6) Check anti-HAV IgG ( if negative > vaccinate)
** ALL 1st degree relatives/sexual partners should be tested (HBsAg/HBsAb/HBcAb) +/- vaccination
Define the following in relation to HBV ttt:
1)Main endpoint?
2)Valuable endpoint?
3)Additional endpoint?
4)Optimal endpoint?
1)The induction of LT suppression of HBV DNA levels.
2)The induction of HBeAg loss +/- Anti-HBe sero-conversion (in HBeAg pos CHB pts)
3)Biochemical response; normalisation of ALT
4) HBsAg loss +/- Anti-HBs sero-conversion (Functional cure).
What are the indications for ttt?
Should be treated:
1) All pts with chronic Hepatitis HBV DNA > 2000 IU/ml and
ALT > ULN and/OR
At least moderate necroinflmmation/fibrosis
2)Cirrhosis (comp/decomp) with any detectable HBV DNA *Regardless of ALT
3)HBV DNA > 20,000 and
ALT > 2ULN
*Regardless of fibrosis degree
May be treated ( Have infection NOT hepatitis):
4)HBeAg-pos + persistent normal ALT + high HBV DNA + > 30Y
*Regardless of fibrosis degree
5)FH of HCC/Cirrhosis and Extra-hepatic manifestation
What A) monitoring and B) how frequent is required for pts NOT on ttt?
A) HBV DNA, ALT, fibrosis (noninvasive).
B)
HBeAg-pos + <30Y = 3-6M
HBeAg-neg + HBV DNA < 2000iu/ml = 6-12M
HbeAg-neg + HBV DNA =/>2000iu/ml = 3M for the 1st Y, then 6M
What is A) the rationale for pegIFNa ttt and B) what is the main disadvantage?
A) Is to induce LT immunological control with finite duration ttt.
B) High variability of response and side effects.
What are the types of ttt response?
Virological
Serological
Biochemical
Histological
Define Virological response to NA ttt?
1)During ttt:
Virological response: HBV DNA ND using PCR with LOD of 10iu/ml
1ry non-response: <1log10 decrease in HBV DNA after 3M of ttt
Partial response: decrease in HBV DNA >1log 10 BUT still detected after 12M of ttt.
Virological breakthrough: increase in HBV DNA >1log10 compared to nadir level on ttt
2)After stopping ttt:
SVR: HBV DNA <2000iu/ml at least 12M post-stopping.
Define virological response to pegIFNa ttt?
On ttt: HBV DNA <2000iu/ml at 6M and at end of ttt
After stopping: HBV DNA <2000iu/ml for at least 12M
Define Histological response to ttt?
Decrease in necroinflammation activity* without worsening in fibrosis compared to pre-ttt findings.
*by =/> 2 points in histologic activity index or Ishaks system🤷🏻♀️
Define sustained biochemical response?
Normal ALT on a minimum follow up 3 monthly for a year post ttt.
