Hepatitis

Question 1

The Hepatitis affect DNA

Answer 1

HBV

Question 2

The only Fecal Oral transmitted Hepatitis

Answer 2

HAV

Question 3

The only Hepatitis that not become chronic or cause cirrhosis and HCC

Answer 3

HAV

Question 4

Hepatitis Vaccine

Answer 4

HAV, HBV

Question 5

Immune due to Vaccination

Answer 5

Anti-HBs (+)

Question 6

Immune due to natural

Answer 6

Anti-HBs + Anti-HBc (+)

Question 7

Infection

Answer 7

HBsAg (+)

Question 8

Acute infection

Answer 8

IgM antiHBc (+)

Question 9

4 Possibilities associated with HBsAg -, anti-HBc + and anti-HBs -

Answer 9

1 . resolved infxn

2. false +
3. low level chronic infection (false - for HBsAg)
4. Resolving Acute infection

Question 10

Five treatment for HCV

Answer 10

1. Ledipasvir/sofosbuvir
2. Paritaprevir/r/ombitasir+ dasabuvir +/- RBV
3. Simeprevir + sofosbuvir +/- RBV
4. sofosbuvir + RBV
5. PEG-interferon + sofosbuvir + RBV

Question 11

Factors affect HCV treatment

Answer 11

Genotype 
Presence of cirrhosis 
DDI 
Renal 
CI 
clinical trial evidence

Question 12

Ledipasvir/sofosbuvir

Harvoni

Answer 12

daily dose
CI: CrCl<30
required acid environment
not recommoned co-administration with statin

12 weeks treatment for all G1 type

Question 13

Paritaprevir/r/ombitasvir + dasabuvir
(Viekira pak

+/- RBV

Answer 13

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

Question 14

simeprevir

Olysio

Answer 14

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

Question 15

Acute Hepatitis presentation

Answer 15

Flu-like illness(malaise, fatigue, myalgia, arthralgia), anorexia, nausea, vomiting, abdominal pain, clay colored stool, dark urine, jaundice, icterus (yellowing of eyes from ↑bilirubin

Question 16

HBV treatment

Answer 16

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)

Question 17

HBV monitoring

Answer 17

Viral load q 3-6 month
renal/liver function
in HBsAg Pt monitor seroconversion

Question 18

Sofosbuvir

sovaldi

Answer 18

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)

Question 19

Ribavirin (RBV)

Answer 19

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

Question 20

G1a no cirrhosis

Answer 20

Ledipasvir/sofosbuvir x 12 weeks**
Paritaprevir/r/ombitasvir + Dasabuvir + RBV x 12 weeks
Simeprevir + sofosbuvir ± RBV x 12 weeks

Question 21

G1a cirrhosis

Answer 21

Ledipasvir/sofosbuvir x 12 weeks
PTV/r/OBV + DSV + RBV x 24 weeks
Simeprevir + sofosbuvir ± RBV x 24 weeks

Question 22

G1b no cirrhosis

Answer 22

LDV/SOF x 12 weeks**
PTV/r/OBV + DSV x 12 weeks (notice no RBV)
SIM/SOF x 12 weeks (notice no RBV)

Question 23

G1b cirrhosis

Answer 23

LDV/SOF x 12 weeks
PTV/r/OBV + DSV + RBV x 12 weeks
SIM/SOF x 24 weeks

Question 24

Class of HCV treatment drugs

Answer 24

Protease Inhibitors - previr
NS5A inhibitor - asvir
NS5B Polymerase Inhibitors - buvir