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BCIDP > Hepatitis > Flashcards

Hepatitis Flashcards

1
Q

Define the following Hepatitis A serologies: Anti-HAV, Anti-HAV IgM and Anti-HAV IgG

A

Anti-HAV (total antibody = IgG + IgM): present/past infection or immunity due to vaccination
Anti-HAV IgM: Current, recent or acute infection
Anti-HAV IgG: Immunity to HAV from past infection or vaccination

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2
Q

What patient populations should be recommended the Hepatitis A vaccination?

A
  1. All children > 1 year of age
  2. Persons with travel to areas with intermediate-high rates of infection
  3. MSM
  4. Illegal and IVDU
  5. Homelessness
  6. Persons with clotting factor disorders
  7. Persons working with HAV-infected primates
  8. Persons with chronic liver disease, including HBV and HCV
  9. Exposed to outbreak
  10. PEP
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3
Q

How would you dose hepatitis A vaccines?

A

Havrix (0 and 6-12 mo) and Vaqta (0, 6-18 mo)

*Havrix has neomycin - avoid in allergy

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4
Q

Which patient population should get HepA immune globulin as pre-exposure prophylaxis?

A

< 6 months or vaccine CI

> 40 years or immunocompromised/chronic liver disease - give HAV vaccine x 1 dose +/- immune globulin

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5
Q

How would you treat for HepA as post-exposure management?

A

Single dose of HAV vaccine or immune globulin within 2 weeks of exposure

< 12 months - immune globulin
> 12 months - 40 years - HAV vaccine
> 40 years or > 12 months + chronic liver disease or immunocompromised - HAV vaccine x 1 dose +/- immune globulin

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6
Q

When would you treat hepatitis B?

A

HBeAg +

Per AASLD, HBV DNA > 20,000 AND ALT > 2xULN OR Cirrhosis

Men: 33 units/L and female 25 units/L

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7
Q

What side effects are related to Peg-interferon?

A

Hepatotoxicity, neutropenia, thrombocytopenia, depression

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8
Q

What are major drug interactions concerns with first-line HepB treatment?

A

TAF - CI with adefovir, carbamazepine, fosphenytoin, Rifampin/Rifabutin/Rifapentine, St Johns Wort

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9
Q

When do you discontinue Hepatitis B treatment?

A

Confirmed HBsAg loss +/- HBsAb seroconversion

Non-cirrhotic HBeAg-positive patients with chronic HBV and stable HBeAg seroconversion + undetectable HBV DNA + 12 mo of therapy

Selected cirrhosis HBeAg negative with long term virologic suppression > 3 years

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10
Q

When should HCV be treated?

A

All patients with chronic HCV infection should be treated (HCV Ab + and HCV DNA +)

Do not treat patients with short term life expectancy regardless of HCV treatment, liver transplantation

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11
Q

Which HCV treatments should receive HS5A RAS resistance testing?

A

Elbasvir/grazoprevier for any patient with genotype 1 A

Ledipasivir/sofobuvir for treatment experienced genotype 1A

Sofosbuvir/velpatasvir for genotype 3 with treatment naive patients with cirrhosis and treatment experienced patients without cirrhosis

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12
Q

What are the medication endings for HC DAAs?

A

NS3/4A Protease Inhibitors: -previr (low barrier to resistance)

NS5A inhibitors: -asvir (Intermediate resistance)

NS5B Nucleotide polymerase inhibitor: -buvir (high barrier to resistance)

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13
Q

When should ribavirin be discontinued?

A

Hgb < 8.5 if no cardiac history
Plt <25K
WBC <1000
ANC < 500

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14
Q

Describe Elbasvir/Grazoprevir contraindications and DDIs?

A

Zepatier for Class 1 and 4
CI with Child Pugh B or C
Genotype 1a: test for NS5A resistance polymorphisms
CI with Moderate/strong CYP3A4 inhibitors and inducers

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15
Q

Describe the contraindications and DDIs with glecaprevir/pibrentasivir

A

Mavyret for all genotypes
Contraindicated Child Pugh Class C
DDIs: Atazanavir, rifampin

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16
Q

Describe the contraindications and DDIs with ledipsavir/sofosbuvir

A

Harvoni for genotype 1 and 4

Contraindicated in pregnancy/male partners of pregnant women when used with RBV

DDIs: CI - amiodarone (symptomatic bradycardia), carbamazepine, oxcarbazepine, phenobarbital, rifabutin/rifampin

Separate antacids/H2 blockers (up to famotidine 40 mg daily) and PPIs (up to 20 mg/daily) - reduces ledipsavir levels

17
Q

Describe the contraindications and DDIs with sofosbuvir/velpatasvir

A

Epclusa for all genotype

Contraindicated with amiodarone (symptomatic bradycardia), CYP2B6 and CYP3A4 inducers

Separate antacids/H2 blockers (up to famotidine 40 mg daily) and PPIs (up to 20 mg/daily) - reduces velpatasvir levels

18
Q

Describe the contraindications and DDIs with sofosbuvir/velpatasvir/voxilaprevir

A

Vosevi for resistance HCV genotype

Contraindicated for Child Pugh B and C

Contraindicated with amiodarone (symptomatic bradycardia), CYP2B6 and CYP3A4 inducers

Separate antacids/H2 blockers (up to famotidine 40 mg daily) and PPIs (up to 20 mg/daily) - reduces velpatasvir levels

19
Q

What is the treatment duration of HCV naive treatments?

A

ELB/GZR: Genotype 1a/1b and genotype 4: 12 weeks
GLE/PIB: All genotypes for 8 weeks
LDV/SOF: Genotype 1a/1b and genotype 4: 12 weeks
SOF/VEL: All genotypes for 12 weeks
SOF/VEL/VOX: for Genotype 3 for 12 weeks

*Only for chronic HCV, no cirrhosis and no previous treatment for HCV

20
Q

How do you treat previously treated PEG or RBV HCV?

A

ELB/GZR:

  • Genotype 1a (no NS5A RASs) - 12 weeks
  • Genotype 1b - 12 weeks
  • Genotype 3 with CIRRHOSIS: 12 weeks + RBV
  • Genotype 4: 12 weeks

GLE/PIB

  • No cirrhosis: 8 weeks EXCEPT 16 weeks in genotype 3 and RBV
  • Cirrhosis: 12 weeks EXCEPT 16 weeks in genotype 3

LDV/SOF

  • No cirrhosis: genotype 1a/1b and genotype 4-6 - 12 weeks
  • Cirrhosis: genotype 1a/1b + RBV and Genotype 4 + RBV, Genotype 5 and 6 - 12 weeks
21
Q

How do you treat PEG/RBV experienced treatment with SOF/VEL and SOF/VEL/VOX?

A

SOF/VEL
- 12 weeks except genotype 3/cirrhosis - 12 weeks + RBV

SOF/VEL/VOX: 12 weeks and ADD RBV in no cirrhosis for genotype 3

22
Q

How do you treat previously treated PEG/RBV and NS3 Protease inhibitors (glecaprevir/grazoprevir/voxilaprevir)?

A

ELB/GZR - 12 weeks + RBV

GLE/PIB - 12 weeks

LDV/SOF - 12 weeks and in cirrhosis 12 weeks + RBV

SOF/VEL - 12 weeks

23
Q

How do you treat SOF experienced HCV?

A

GLE/PIB - 12 weeks

LDV/SOF - in no cirrhosis: 12 weeks + RBV

SOF/VEL - ONLY in genotype 1b : 12 weeks

SOF/VEL/VOX - 12 weeks

24
Q

How do you treat glecaprevir/pibrentasvir treatment failure?

A

GLE/PIB: all genotypes for 16 weeks + SOF + RBV

SOF/VEL/VOX: 12 weeks and consider RBV in cirrhosis

25
Q

How do you treat HCV in decompensated cirrhosis?

A

LDV/SOF

  • RBV eligible: 12 weeks for genotype 1, 4-6
  • RBV ineligible or SOF or NS5A failure: 24 weeks for genotypes 1, 4-6

SOF/VEL

  • RBV eligible: 12 weeks for all genotypes
  • RBV ineligible or SOF failure or NS5A failure: 24 weeks for all genotypes
26
Q

Which HCV treatments should be avoided due to renal dysfunction with TDF?

A

Ledipasvir/Sofosbuvir
Sofosbuvir/Velpatasvir
Sofosbuvir/Velpatasvir/Voxilaprevir

27
Q

What HCV treatments should be avoided with ritonavir?

A

Glecaprevir/Pibrentasvir

Sofosbuvir/Velpatasvir/Voxilaprevir

28
Q

What HCV treatments should be avoided with cobicstat?

A

Elbasvir/Grazoprevir
Glecaprevir/Pibrentasvir
Sofosbuvir/Velpatasvir/Voxilaprevir

29
Q

What HCV therapies should TDF be avoided with?

A

Ledipasvir and velpatasvir

30
Q

What counseling point should be said with entecavir?

A

Take 2 hours before or after a meal

31
Q

Which HCV treatment regimens is CI with decompensated cirrhosis?

A

Zepatier, Mavyret, Vosevi

32
Q

Which SOF- based regimens should have ribavirin in combination? What scenarios?

A

Harvoni - all genotypes with compensated cirrhosis

Epclusa - genotype 3 with compensated cirrhosis or Y93H present

BCIDP (13 decks)

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