Hepatitis Flashcards
The Hepatitis affect DNA
HBV
The only Fecal Oral transmitted Hepatitis
HAV
The only Hepatitis that not become chronic or cause cirrhosis and HCC
HAV
Hepatitis Vaccine
HAV, HBV
Immune due to Vaccination
Anti-HBs (+)
Immune due to natural
Anti-HBs + Anti-HBc (+)
Infection
HBsAg (+)
Acute infection
IgM antiHBc (+)
4 Possibilities associated with HBsAg -, anti-HBc + and anti-HBs -
1 . resolved infxn
- false +
- low level chronic infection (false - for HBsAg)
- Resolving Acute infection
Five treatment for HCV
- Ledipasvir/sofosbuvir
- Paritaprevir/r/ombitasir+ dasabuvir +/- RBV
- Simeprevir + sofosbuvir +/- RBV
- sofosbuvir + RBV
- PEG-interferon + sofosbuvir + RBV
Factors affect HCV treatment
Genotype Presence of cirrhosis DDI Renal CI clinical trial evidence
Ledipasvir/sofosbuvir
Harvoni
daily dose
CI: CrCl<30
required acid environment
not recommoned co-administration with statin
12 weeks treatment for all G1 type
Paritaprevir/r/ombitasvir + dasabuvir
(Viekira pak
+/- RBV
complected dosing
DDIs in CYP
photosensitivities
Risk of HIV-1 protease inhibitor resistance in HIV co-infect.
Max of 10mg rosuvastatin, 40mg of pravastatin daily
if used with ribavirin, ↑risk of ALT elevations, risk of HIV-1 protease inhibitor resistance in HIV co-infection
W/ RBV for all G1a
W/O RBV for all G1b
mostly 12 weeks except 1a cirrhosis for 24 wks
simeprevir
Olysio
Take one 150mg capsule once daily with food
sulfa allergy
DDIs with Cobicistat, Efavirdine, delavirdine, etravirine, nevirapine, ritonovir
limited statin doses
Rosuvastatin 10mg, Atorvastatin 40mg
normally use with SOF
for all G1 12 wks
if cirrhosis 24 weeks
Acute Hepatitis presentation
Flu-like illness(malaise, fatigue, myalgia, arthralgia), anorexia, nausea, vomiting, abdominal pain, clay colored stool, dark urine, jaundice, icterus (yellowing of eyes from ↑bilirubin
HBV treatment
Tenofovir 300mg PO daily – 1st line: Renal dose adjustment Entecavir 1mg PO daily- 1st line: Renal dose adjustment Lamivudine 100mg PO daily- 2nd line: Renal dose adjustment (dosing in HIV is 150mg PO BID or 300mg PO daily)
HBV monitoring
Viral load q 3-6 month
renal/liver function
in HBsAg Pt monitor seroconversion
Sofosbuvir
sovaldi
400mg PO daily
CI: CrCl <30
(when given with RBV or PEG-IFN + RBV) diarrhea, anemia, headache, insomnia, fatigue
DDI:Tipranavir/r
St. John’s Wort
Anticonvulsants (CBZ, PHE, PHB, OXZ)
Antimycobacterials (rifampin, rifabutin, rifapentine)
Ribavirin (RBV)
Usually weight-based:
If ≤ 75kg 1000mg daily (400mg in AM, 600mg in PM) with food
If > 75kg 1200mg daily (600mg in AM, 600mg in PM) with food
SE: bone marrow suppresion
BBW: cardiac disease, Hgb <8, Pregnancy X - need contraception for 6 month after completion of treatment for both partners
No effect as mono therapy
G1a no cirrhosis
Ledipasvir/sofosbuvir x 12 weeks**
Paritaprevir/r/ombitasvir + Dasabuvir + RBV x 12 weeks
Simeprevir + sofosbuvir ± RBV x 12 weeks
G1a cirrhosis
Ledipasvir/sofosbuvir x 12 weeks
PTV/r/OBV + DSV + RBV x 24 weeks
Simeprevir + sofosbuvir ± RBV x 24 weeks
G1b no cirrhosis
LDV/SOF x 12 weeks**
PTV/r/OBV + DSV x 12 weeks (notice no RBV)
SIM/SOF x 12 weeks (notice no RBV)
G1b cirrhosis
LDV/SOF x 12 weeks
PTV/r/OBV + DSV + RBV x 12 weeks
SIM/SOF x 24 weeks
Class of HCV treatment drugs
Protease Inhibitors - previr
NS5A inhibitor - asvir
NS5B Polymerase Inhibitors - buvir
