hep tx Flashcards
surface antigen for Hep ___ and antibody for Hep ___
B
C
Risk factors of Hep C
Injection drug use*****
Baby boomer
multiple sexual partners
incarceration, occupational
long term hemodialysis
blood transfusion prior to 1992
clotting factor tx prior to 1987
Hep B therapy patient requirements
positive HBsAG
HBeAG(+/- will change tx)
ALT
FDA tx for Hep B
First line
- PEG-IFN
- Entecavir
- Tenofovir
Second Line tx
- IFN
- Lamivudine
- Adefovir
- Telbivudine
Hep B, even in the absence of cirrhosis, can predispose to
HCC
What is the first test that becomes positive for Hep B?
surface antigen
window period is
loss of surface antigen before anti-HBs, some IgM-HBc (24-32 weeks)
Which serological markers are present in chronic infection of Hep B?
HBsAg and total antiHBc
not necessarily IgM anti-HBc
what is eAntigen?
mark of viral replication
Which marker is in actively infected Hep B patient versus someone who could be immunized?
HBsAg is the main marker for infectivity
HBsAb in both immunized and exposed
what is eAntigen?
mark of viral replication
assess treatment response
Which marker is in actively infected Hep B patient versus someone who could be immunized?
HBsAg is the main marker for infectivity
HBsAb in both immunized and exposed
Acute hep B marker and important for what other hepatitis?
Hep B Core Antibody IgM (HBc IgM) important for Hepatitis D infectiond
Hepatits Core Ab IgM + IgG total
someone exposed
Hep B surface Antibody no core Ab
immunized
Quantitative assay reports
viral load to assess treatment response
Inactive Chronic Hep B
HBsAg+> 6 months
no HBeAGg, HBeAb
HBV DNA <2,000
normal AST/ALT
liver biopsy without significant hepatitis
Interferon
not well tolerated but great sAg loss
Lamivudine
high risk of resistance, could be used for viral suppression during chemo
Telbivudine
used in Asia
Entecavir
common but low sAg loss.
Sexual blood exposures should be avoided in
Hep B
Check for HBsAg in all patients about to initiate
chemo
Mother with Hep B pregnant, what should be done?
immunize the baby immediately and HBIg
Tenofovir and Telbivudine can be used for
pregnant mothers in the 3rd trimester
fulminant hep b serology
HBsAg+, HBc IgM+
mot important screening for HCC for which hepatitis
Hepatitis B
Hep C most prevalent
Egypt
what percentage of Acute HCV turns to chronic infection and percentage to cirrhosis?
70-85% (Anti-HCV Ab+, HCV RNA +), 30% to cirrhosis
HCV IgG Ab is not diagnostic, what is?
RNA by PCR
common Hep genotypes in US
1a, 1b
HCV IgG Ab is not diagnostic, what is used to confirm infected state?
RNA by PCR
common Hep genotypes in US
1a, 1b
What leads to a more rapid and progressive course of HCV
Alcohol
what else should you test for in HCV infected person?
HIV (30% HIV+ concomitantly infected with HCV)
extrahepatic Hep C manifestations?
Porphyria cutanea tarda
Leukocytoclastic vasculitis
Glomerulonephritis
Non-Hodgkin’s lymphoma
AutoI thyroiditis
DM
Sjogren’s
Sustained Virological Response code word for
hep c is CURED
PEG-IFN/RBV side affect
suicide
What class of drugs are direct acting HCV therapies?
reference
NS3/4A protease inhibitors
NS5B Nucleotide Polymerase Inhibitor
NS5B Non-nucleotide Polymerase Inhibitor
NS5A Inhibitors
Genotype 1 drug?
Harvoni (1)
Viekira Pak (1ab)
Zepatier
Genotype 1-6 drug
Epclusa
