HBV Treatment

Question 1

current recommendations for chronic HBV treatment

Answer 1

entecavir, TAF, TDF, pegylated interferon alfa 2a

Question 2

pegylated interferon alfa 2a dose

Answer 2

180 mcg weekly

Question 3

entecavir dose

Answer 3

0.5 mg daily naive, 1 mg daily

Question 4

TDF dose

Answer 4

300 mg daily

Question 5

TAF dose

Answer 5

25 mg daily

Question 6

actions of interferons

Answer 6

induce resistance to viral replication in all cells, increase MHC Class I expression and antigen presentation, activate NK cells to kill virus-infected cells

Question 7

dose of pegylated interferon alfa 2a if CrCL< 30 mL/min

Answer 7

135 mcg weekly

Question 8

interferon adverse effects

Answer 8

influenza like illness, fatigue, wt loss, hairloss, myelosuppression, psychiatric (suicidal), etc

Question 9

interferon contraindications

Answer 9

severe uncontrolled depressive disorder, suicidal ideation, decompensated liver disease, neutropenia, thrombocytopenia, pregnancy, babies, others

Question 10

duration of pegasys (peginterferon alpha 2a) therapy

Answer 10

48 weeks

Question 11

peginterferon is pregnancy category _

Answer 11

C

Question 12

peginterferon contains ____

Answer 12

benzyl alcohol

Question 13

renal dosing for entecavir

Answer 13

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

Question 14

TDF renal dosing

Answer 14

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

Question 15

adverse effects of entecavir

Answer 15

lactic acidosis

Question 16

adverse effects of tenofovir AF

Answer 16

lactic acidosis, nephropathy, fanconi syndrome

Question 17

adverse effects of TDF

Answer 17

nephropathy, fanconi syndrome, osteomalacia, lactic acidosis

Question 18

treatment in renal and bone disease

Answer 18

no preference btwn TDF and entecavir. if TDF associated bone/renal disease–> TAF.

Question 19

TAF metabolism?

Answer 19

p-gp substrate, inducers contraindicated

Question 20

TAF, CrCL <15?

Answer 20

not recommended

Question 21

TAF dose/food

Answer 21

25 mg daily with food

Question 22

TAF drug interaction with carbamazepine

Answer 22

carbamazepine inducer: decreases TAF exposure by half

Question 23

TAF drug interaction with cobicistat

Answer 23

inhibitor: increases TAF exposure

Question 24

what other drugs interact with TAF

Answer 24

harvoni and epclusa

Question 25

safety in HBV treatment with nucleos(t)ide analogues

Answer 25

low AE profile, safe in immunocompromised, all stages of liver disease, indefinite treatment duration, resistance

Question 26

safety in HBV treatment with interferons

Answer 26

many AE, contraindications, limited treatment duration, no resistance

Question 27

phases of chronic hepatitis b infection

Answer 27

immune tolerant, immune active, inactive CHB, immune reactivation

Question 28

during which phases of CHB is HBV DNA elevated?

Answer 28

immune tolerant, immune active, reactivation

Question 29

during which phases of CHB is ALT elevated?

Answer 29

immune active, reactivation

Question 30

during which phase of CHB is there liver injury?

Answer 30

immune active

Question 31

during which phase of CHB is there necroinflammation and fibrosis?

Answer 31

immune reactivation

Question 32

when to treat for immune active CHB

Answer 32

generally do. ALT >2x ULN, liver injury, HBeAg- 2000, HBeAg +20,000

Question 33

when to treat for immune tolerant CHB

Answer 33

generally don't, if everything looks good. monitor.

Question 34

when to treat after HBeAg seroconversion

Answer 34

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.

Question 35

when to treat after HBeAg seroconversion with cirrhosis?

Answer 35

kind of a grey area: things to balance-- cost, adverse effects, resistance. relapse, decompensation, HCC.. just realize it is difficult to decide

Question 36

if people don't convert?

Answer 36

indefinite antiviral therapy

Question 37

role for duel therapy?

Answer 37

breakthrough on monotherapy.

Question 38

treatment options for cirrhosis?

Answer 38

interferon is NOT an option. tenofovir and entecavir preferred.

Question 39

HBV for pregnancy?

Answer 39

HBV DNA >200,000. start at 28-32 weeks gestation: TDF, lamivudine, telbivudine, breastfeeding not contraindicated.

Question 40

HBV treat for children?

Answer 40

we should if they have immune active: elevated ALT, HBV DNA.

Question 41

which HBV drugs for children >2 (not rlly on test)

Answer 41

lamivudine, entecavir, TDF

Question 42

which HBV drugs for children >12 (not rlly on test)

Answer 42

adefovir, TAF