Hepatitis

Question 1

What is the treatment for chronic hepatitis B? (4)

Answer 1

• Entecavir: PO 500 mcg OD
• Peginterferon alfa: SC
• Tenofovir alafenamide: PO 25 mg OD
• Tenofovir disoproxil: PO 245 mg OD

Question 2

What is the treatment for chronic hepatitis B in patients with decompensated liver disease? (2)

Answer 2

• Entecavir: PO 1mg OD

- Tenofovir disproxil: PO 245 mg once daily

Question 3

What are the monitoring requirements for Tenofovir disproxil?

Answer 3

Test renal fx and serum phosphate before tx, and then every 4 weeks for 1 year and then every 3 months.
Interrupt tx if renal fx deteriorates or serum phosphate decreases.

Question 4

What are the monitoring requirements for Entecavir?

Answer 4

Monitor liver fx tests every 3 months

Viral markers for hep B every 3-6 months during tx (continue monitoring for a at least a year)

Question 5

What are the monitoring requirements for Peginterferon alfa?

Answer 5

Monitoring of lipid concentration is recommended

Question 6

What are the monitoring requirements for Tenofovir alafenamide?

Answer 6

HIV antibody testing should be offered to those with unknown status.

Liver fx tests at repeated intervals during tx and for at least 6 months after last dose. recurrent hepatitis may occur on discontinuation.

Question 7

What drugs can be used to treat chronic hepatitis C infection

Answer 7

• Sofosbuvir with ribavirin: PO 400 mg OD
• Sofosbuvir with velpatasvir: PO 400/100 mg OD
• Sofosbuvir with velpatasvir and voxilaprevir: PO 1 tablet
• Glecaprevir with pibrentasvir: PO 300/120mg OD

Question 8

If eGFR is less than (?) use caution when prescribing Sofosbuvir

Answer 8

30 mL/minute/1.73 m2

Question 9

What drugs treat Chronic Hepatitis C infection of genotypes 1, 3, 4, 5, or 6

Answer 9

Ledipasvir with sofosbuvir:

PO 90/400 mg OD

Question 10

What drugs treat Chronic Hepatitis C infection of genotypes 1 or 4.

Answer 10

Elbasvir with grazopprevir:

PO 50/100 mg OD for 12 wks

Question 11

What needs to be monitored when when taking Elbasvir with grazopprevir?

Answer 11

• INR
• glucose levels as there is a risk of hypoglycaemia, especially within 3 months.
• Liver function before tx, at week 8 in all patients, at week 12 in patients receiving 16 weeks of treatment

Question 12

Who is considered high risk for hepatitis A and so who should take the Hepatitis A vaccine?

Answer 12

• laboratory staff who may be exposed to the virus
• staff and residents of homes for those with severe learning difficulties, or where personal hygiene among patients may be poor.
• workers at an untreated sewage
• individuals who work with primates
• patients with haemophilia being treated with plasma-derived clotting factors
• patients with severe liver disease regardless of the cause.
• Specific travel
• High risk sexual behaviour
• Parenteral drug users

Question 13

When is the Hepatitis B vaccine given first

Answer 13

As part of the 6 in 1 vaccine under 1 year old.

Question 14

Who is considered high risk for hepatitis B and so who should take the Hepatitis B vaccine?

Answer 14

Parenteral drug user and their sexual partners, household contacts and close family contacts
- high risk sexual behaviour
- patients receiving regular blood transfusions or blood products and their carer
- patients with chronic renal failure
- patients on haemodialysis or a renal transplantation programme
- patients with severe liver disease regardless of the cause
- healthcare workers who may have direct contact with patients’ blood, or tissues
- lab staff who may handle the virus
- morticians and embalmers
staff and residents of homes for those with learning difficulties
- staff and inmates of custodial institutions
- Certain travel
- Some foster carers and their families