Hep viruses

Question 1

Relapse after sofosbuvir/ledipasvir - what next?

Answer 1

Sofosbuvir/Velpatasvir/Voxilaprevir

Question 2

Which genotypes to use sofosbuvir/ledipasvir?

Answer 2

1 and 4

Question 3

How to tx genotype 3?

Answer 3

sofosbuvir/velpatasvir or glecaprevir/pibrentasvir

Question 4

How to tx pt on dialysis with HCV GT1a?

Answer 4

Elbasvir/Grazoprevir

Question 5

Sofosbuvir/Velpatasvir treatment duration for HCV GT 1a in pts with cirrhosis?

Answer 5

12 weeks

Question 6

How long after exposure and infection with HCV does it take AB to develop?

Answer 6

6 weeks - so if suspect infxn prior just check HCV RNA

Question 7

What is immune tolerant phase of HBV?

Answer 7

1st 20-30 yrs in vertical transmission - norml LFTs but high HBV DNA, HBeAg+ but AB -

Question 8

What is immune clearance phase of HBV?

Answer 8

Start to fight virus, LFTs go up and HBeAB turns positive, HBV DNA may decline - after immune tolerant

Question 9

What is HBV inactive carrier phase?

Answer 9

After immune clearance - will have low HBV DNA and +HBeAB, normal LFTs

Question 10

If HBV DNA ~20,000 and normal LFTs, what is best tx?

Answer 10

Monitor LFTs every 6 months

Question 11

What is best med for HBV seroconversion from HBeAg to HBeAB+ and HBsAg to HBsAB+?

Answer 11

peginterferon alfa 2a

Question 12

Which pts at risk for fulminant liver fx with HAV if infected?

Answer 12

HCV pts

Question 13

Pt with acute HAV - what to offer to household contacts at risk of dz?

Answer 13

HAV Immune globulin

Question 14

Do pts with previous HBV exposure and clearance need monitoring of labs or tx when starting infliximab for IBD?

Answer 14

No, no action needed

Question 15

If chronic hep B and starting infliximab, wat should be done?

Answer 15

Start entecavir

Question 16

If previous HBV clearance and starting chemotx for CA, what should be done?

Answer 16

HBV ppx during tx and for 12-18 months following tx.

Question 17

HCV GT1B and reflux on PPI, which drug regimen to use?

Answer 17

grazoprevir/elbasvir

Question 18

Which drugs interact with PPI?

Answer 18

Sofosbuvir/ledipasvir, sofosbuvir/velpatasvir

Question 19

T/F: If starting grazoprevir/elbasvir, pts with HCV GT1B should have NS5A RAV testing.

Answer 19

False, 1A pts should have resistance testing, 1B do not need it.

Question 20

If fail primary HCV tx (ie sofosbuvir/ledipasvir), what should be used next for tx?

Answer 20

sofosbuvir/velpatasvir/voxilaprevir - approved in GT 1-6

Question 21

T/F: PPX should be used in pts with HBsAg-negative/anti-HBc+ serologic profile who are being treated with prednisone >20 mg daily (or equivalent) for ≥ 4 weeks or are on chronic moderate dose prednisone therapy (10-20 mg daily) during treatment and for at least 6 months after stopping immunosuppression.

Answer 21

True - 1-10% risk of reactivation

Question 22

T/F: Sofosbuvir/ledipasvir can be used for GT2 HCV.

Answer 22

False, use Glecaprevir/pibrentasvir

Question 23

T/F: Sofosbuvir should not be used in GFR <30

Answer 23

True

Question 24

What should tx GT2 or 3 pt with GFR < 30?

Answer 24

Glecaprevir/pibrentasvir

Question 25

T/F: Glecaprevir/pibrentasvir is OK to use in decompensated cirrhosis.

Answer 25

False, it is poorly tolerated in advanced cirrhotics

Question 26

T/F: Tx with IVIG can lead to transient HBcAB+?

Answer 26

True

Question 27

Which women should get HBV tx in 3rd TM of pregnancy?

Answer 27

if VL > 200,000

Question 28

Which HBV tx approved in pregnancy?

Answer 28

Tenofovir, telbivudine

Question 29

What are 1st line drugs in HBV when needed?

Answer 29

Tenofovir or entecavir

Question 30

Decomp cirrhosis with CTP-B - what should be used for tx?

Answer 30

Ledipasvir + sofosbuvir + ribavirin

Question 31

If pt with HBV and seroconverts from eAB-/eAg+ to eAB+/eAg- while on tx with entecavir what should be done going forward?

Answer 31

Continue tx for 1 year after seroconversion prior to discussing d/c meds

Question 32

When should start HCC surveillance in black man without cirrhosis with HBV?

Answer 32

Age 40, like Asian

Question 33

Who to tx for HBV?

Answer 33

if eAg- : ALT > 2x ULN and DNA > 2K | If eAg+ : ALT > 2x ULN and DNA > 20K

Question 34

What are CI to PEG-IFN?

Answer 34

Psych dz, decomp cirrhosis, AI dz, cytopenias, cardiac dz

Question 35

Who is at risk of HSV hepatitis?

Answer 35

ICed and post partum pts

Question 36

Who is at higher risk of HEV infxn?

Answer 36

Men over 40 esp after exposure to farm animals

Question 37

T/F: Hepatitis A can have a relapsing course that can go on for up to a year.

Answer 37

True

Question 38

post exposure ppx for HAV?

Answer 38

Vaccine in 1-40 yo, IG in > 40 yo

Question 39

Post TP pt with CMV - what to tx with?

Answer 39

IV ganciclovir or PO valganciclovir

Question 40

T/F: HBV with cirrhosis should be tx for HBV regardless of LFTs.

Answer 40

True - may help induce some regression of histology

Question 41

Which HCV med cannot be combined with amiodarone?

Answer 41

Sofosbuvir - can lead to life threatening arrhythmias

Question 42

Which HCV med cannot be combined with statins?

Answer 42

glecaprevir/pibrentasvir - risk of rhabdo with statins

Question 43

WHat can be used to tx HCV in renal dz pts with severe dz or on HD?

Answer 43

GT1 - elbasvir/grazoprevir | GT1-6 - glecaprevir/pibrentasvir