HBV Treatment Flashcards
current recommendations for chronic HBV treatment
entecavir, TAF, TDF, pegylated interferon alfa 2a
pegylated interferon alfa 2a dose
180 mcg weekly
entecavir dose
0.5 mg daily naive, 1 mg daily
TDF dose
300 mg daily
TAF dose
25 mg daily
actions of interferons
induce resistance to viral replication in all cells, increase MHC Class I expression and antigen presentation, activate NK cells to kill virus-infected cells
dose of pegylated interferon alfa 2a if CrCL< 30 mL/min
135 mcg weekly
interferon adverse effects
influenza like illness, fatigue, wt loss, hairloss, myelosuppression, psychiatric (suicidal), etc
interferon contraindications
severe uncontrolled depressive disorder, suicidal ideation, decompensated liver disease, neutropenia, thrombocytopenia, pregnancy, babies, others
duration of pegasys (peginterferon alpha 2a) therapy
48 weeks
peginterferon is pregnancy category _
C
peginterferon contains ____
benzyl alcohol
renal dosing for entecavir
CrCL >50= 0.5 mg daily
CrCL 30-49= 0.5 mg q48h
CrCL 10-12= 0.5 mg q72h
CrCL <10 or HD= 0.5 mg weekly
TDF renal dosing
CrCL>50= 300 mg daily
CrCL 30-49= 300 mg q48h
CrCL 10-29= 300 mg q72-96h
CrCL <10 or HD= 300 mg weekly
adverse effects of entecavir
lactic acidosis
adverse effects of tenofovir AF
lactic acidosis, nephropathy, fanconi syndrome
adverse effects of TDF
nephropathy, fanconi syndrome, osteomalacia, lactic acidosis
treatment in renal and bone disease
no preference btwn TDF and entecavir. if TDF associated bone/renal disease–> TAF.
TAF metabolism?
p-gp substrate, inducers contraindicated
TAF, CrCL <15?
not recommended
TAF dose/food
25 mg daily with food
TAF drug interaction with carbamazepine
carbamazepine inducer: decreases TAF exposure by half
TAF drug interaction with cobicistat
inhibitor: increases TAF exposure
what other drugs interact with TAF
harvoni and epclusa
safety in HBV treatment with nucleos(t)ide analogues
low AE profile, safe in immunocompromised, all stages of liver disease, indefinite treatment duration, resistance
safety in HBV treatment with interferons
many AE, contraindications, limited treatment duration, no resistance
phases of chronic hepatitis b infection
immune tolerant, immune active, inactive CHB, immune reactivation
during which phases of CHB is HBV DNA elevated?
immune tolerant, immune active, reactivation
during which phases of CHB is ALT elevated?
immune active, reactivation
during which phase of CHB is there liver injury?
immune active
during which phase of CHB is there necroinflammation and fibrosis?
immune reactivation
when to treat for immune active CHB
generally do. ALT >2x ULN, liver injury, HBeAg- 2000, HBeAg +20,000
when to treat for immune tolerant CHB
generally don’t, if everything looks good. monitor.
when to treat after HBeAg seroconversion
we want the HB envelope antigen (HBeAg) to be negative. emergence of anti-Hbe (envelope). but don’t stop when it emerges, generally consolidate for 12 months with persistent normal ALT, negative HBV DNA, monitor q3m post cessation.
when to treat after HBeAg seroconversion with cirrhosis?
kind of a grey area: things to balance– cost, adverse effects, resistance. relapse, decompensation, HCC.. just realize it is difficult to decide
if people don’t convert?
indefinite antiviral therapy
role for duel therapy?
breakthrough on monotherapy.
treatment options for cirrhosis?
interferon is NOT an option. tenofovir and entecavir preferred.
HBV for pregnancy?
HBV DNA >200,000. start at 28-32 weeks gestation: TDF, lamivudine, telbivudine, breastfeeding not contraindicated.
HBV treat for children?
we should if they have immune active: elevated ALT, HBV DNA.
which HBV drugs for children >2 (not rlly on test)
lamivudine, entecavir, TDF
which HBV drugs for children >12 (not rlly on test)
adefovir, TAF
