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HEPATITIS Flashcards

1
Q

Type A

A

ssRNA
fecal-oral transmission
acute
NOT oncogenic

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2
Q

Type B

A

dsDNA
blood borne and/or sexual
acute &/or chronic
YES oncogenic

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3
Q

Type C

A

ssRNA
blood borne and/or sexual
chronic
YES oncogenic

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4
Q

Type D

A

ssRNA
blood borne and/or sexual
Chronic
UKNOWN oncogenic

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5
Q

Type E

A

ssRNA
Fecal-oral transmission
chronic
NOT oncogenic

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6
Q

Score 1 =

A

mild fibrosis
fibrous portal expansion
periportal fibrotic expansion

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7
Q

Score 2 =

A

moderate fibrosis
rare bridges or septa
periportal septa (>1 septum)

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8
Q

Score 3 =

A

severe fibrosis
numerous bridges or septae
portal-central septae

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9
Q

Score 4 =

A

cirrhosis
numbered bridges or septa
cirrhosis

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10
Q

Class A =

A

5-6 points
least severe liver disease

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11
Q

Class B =

A

7-9 points
moderately severe liver disease

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12
Q

Class C =

A

10-15 points
most severe liver disease

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13
Q

HBsAg

A

Hep B SURFACE
- Detectable at sx onset (acute and chronic)

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14
Q

HBeAg

A

Hep Be
- marker of replication and infectivity

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15
Q

Anti-HBeAg

A

-replaces HBeAG once infection or NO HBV replication
-reversion to HBeAg+ may occur

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15
Q

Anti-HBsAg

A

develops from HBV infection OR vaccination

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15
Q

HBcAg

A

Hep B core
- protein promoting immune-mediated cell death
- ONLY present infection

16
Q

IgM Anti-HBcAg

A

-detectable in acute (< 6mo)

17
Q

IgG Anti-HBcAg

A

-replaces IgM Ab and PERSISTS LIFELONG (chronic >6mo)

18
Q

Pegylated Interferon a-2a, a-2b (Pegasus, Pegintron) MOA and dose

A
  • inhibit viral replication, immunomodulatory; seroconversion advantage over PO anti-HBV agents
  • Peg-IFN a-2a( 18+mo) = 180 mcg SQ weekly
  • IFN a-2b (1+ y) = 3M IU/m2 SQ 3x/wk then 6M IU/m2 SQ 3x/wk
19
Q

Pegylated Interferon a-2a, a-2b (Pegasus, Pegintron)
CONTRAINDICATIONS

A
  • uncontrolled major depression
  • suicidal ideation
  • autoimmune hepatitis or disease
  • solid organ transplant
  • decompensated cirrhosis or HCC
  • uncontrolled thyroid disorder
20
Q

Entecavir (Baraclude)
MOA, dose

A
  • guanosine nucleoside analog inhibits HBV DNA replication
  • 0.5mg PO daily (naive)
  • 1mg PO daily (lamivudine resistance/refractory)
  • wt-based (peds; 2+yo)
  • dose reduction in renal dx
21
Q

Entecavir (Baraclude)
administration

A

EMPTY STOMACH; > 2H before or after meal
–well-tolerated. stopping abruptly = HBV exacerbated

22
Q

Tenofovir disoproxil fumarate (TDF, Viread)
MOA & dose

A
  • adenosine nucleotide analog inhibits HBV DNA replication
  • 35+ kg: 300mg PO daily
  • 2 oz and 10 + kg: wt-based
  • dose reduction in renal dysfunction
23
Tenofovir disoproxil fumarate (TDF, Viread) ADE
-nausea, nephrotoxicity, osteomalacia, Falconi syndrome - stopping abruptly=HBV exacerbation
24
Tenofovir alafenamide (TAF, Vemlidy) MOA & dose
- Phosphonamidate prodrug of tenor; adenosine nucleotide analog inhibits HBV DNA replication - adults (18+): 25mg PO daily w/ food - **AVOID ECrCl , 15mL/min
25
Tenofovir alafenamide (TAF, Vemlidy) ADE
- stopping abruptly=HBV exacerbation - HA, ab pain, cough, backache, fatigue - Less BMD decreases and nephrotoxicity vs TDF
26
Non-preferred HBV Therapy
- lamivudine (Epivir-HBV) - Emtricitabin (Emtriva) - Adefovir (Hepsera) - Telbivudine (Tyzeka)
26
HBV/HIV Co-infection
-Emtricitabine, lamivudine, TDF & TAF -TDF/em;la TAF/em
27
HBV/HIV Co-infection alternative
entecavir w/ suppressive HIV regimen **continue HBV active agents if HIV virologic failure**
28
Adults DOT
Nucleos(t)ide analogs: - 12+ for HBeAg w/ or w/o cirrhosis....NOT FINISHED - Peg-IFN-a: 48 wks
29
Children DOT
IFN-2b: 24 weeks antivirals: > 1yr until > 1 yr after HBeAg seroconversion
30
HCV Testing Recommendations
- 1-time, routine, opt out for 18 & 18+ - 1-time 18-<18 y if risky activities, exposures, or conditions or circumstances - routine prenatal care w/ each pregnancy - periodically if risky activities, exposures, or conditions/ circumstances - annually: IVDU, HIV (+) MSM unprotected sex, and MSM taking PrEP
31
DAAs MOA
Direct acting antivirals (DAAs): target specific nonstructural (NS) proteins for HCV leading to disruption in viral replication and infection
31
HCV Life Cycle
1. receptor binding & endocytosis 2. Fusion & uncoating 3. Translation & polyprotein processing 4. RNA replication 5. Virion assembly 6. transport & release
31
Velpatasvir/sofosbuvir (Epclusa) -PANGENOTYPIC DDIs
- H2RAs: simultaneously w/ or 12hrs apart; avoid comparable doses > famotidine 40mg BID - PPIs: not recommended; if needed, take Epclusa W/ FOOD & 4hrs before Omeprazole 20mg daily - indicated for GT 1-6 - 3+
32
Ledipasvir/sofosbuvir (Harvoni) DDIs
- H2RAs: simultaneously w/ or 12hrs apart; avoid comparable doses > famotidine 40mg BID - PPIs: simultaneously w/ fasting conditions; avoid comparable doses > omeprazole 20mg daily - indicated for GT 1,4,5,6; GT1 decomposition cirrhosis + RBV; GT1 or 4 liver transplant pt w/o cirrhosis or compensated cirrhosis + RBV - 3+
32
Glecaprevir/pribrentasavir (Mavyret)
-take with food - CI: mod-sev. hepatic impairment (CTP class B or C); h/o prior hepatic decompression; coadministration w/ atazanavir and rifampin - indicated for GT 1-3, GT1 prev. treated w/ NS5A or NS3/4A - 3+
33
Elbasvir/grazoprevir (Zepatier)
- CI: mod-sev hepatic impairment - indicated for GT 1 or 4 --12+ and 30+ kg
33
Sofosbuvir/velpatasvir/voxilaprevir (Vosevi)
- take w/ food - DDI: many! see Epclusa - CI: coadministration with rifampin - indicated for GT 1-6, GT 1a or 3 - ADULTS

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