Hepatitis B, C

Question 1

Hep B - interpretations

HbsAg negative
anti-Hbc negative
anti-Hbs negative

Answer 1

susceptible –> should vaccinate

Question 2

Hep B - interpretations

HbsAg negative
anti-Hbc positive
anti-Hbs positive

Answer 2

inactive infection

Question 3

Hep B - interpretations

HbsAg negative
anti-Hbc negative
anti-Hbs positive

Answer 3

vaccinated

Question 4

Hep B - interpretations

HbsAg positive
anti-Hbc positive
IgM anti HBc positive
anti-Hbs negative

Answer 4

acute HBV infection

Question 5

Hep B - interpretations

HbsAg positive
anti-Hbc positive
IgM anti HBc negative
anti-Hbs negative

Answer 5

Chronic HBV

Question 6

Treatment HBV

Monitoring

Answer 6

Nucleoside analogues and nucleotide analogues

1. Entacavir
2. Tenofovir Disoproxil Fumarate (TDF)
3. Tenofovir alafenamide (TAF)

Interferon

advanced fibrosis - cont treatment despite seroconversion

Monitor with ALT + HBC DNA every 3 months

Question 7

HCC surveillance

Answer 7

USS and AFP every 6 m especially for high risk

Question 8

A/E and disadvantages

Nucleoside analogues and nucleotide analogues

Answer 8

lifelong treatment

risk - renal impairment

Question 9

A/E and disadvantages

Interferon

Answer 9

Flu like symptoms, worsen liver disease

poor response rate in high HBV DNA levels

defined 48 week treatment but weekly s/c injection

Question 10

HBV + Hepatitis

Answer 10

Do not given single agent , used TAF/TDF + emtricitabine

Question 11

HBV + cancer

Answer 11

Screen prior to chemotherapy, is HBsAg +ve use antivirals!

Ritux - highest risk of hep B reactivation

Question 12

HBV + pregnancy

Answer 12

if taking don’t stop –> risk of severe flare

if child bearing age, stop meds prior to pregnancy

if viral load high - lamuvidine + tenofovir

• don’t use entacavir
• consider cont till 4-12 w post partum

Vaccination + Hep B IVIG within 12 hours of birth

Question 13

HCV

Screening and follow up

Answer 13

• Screen at risk groups
• Treat everyone
• If no sx of cirrhosis –> nil need for follow up
• Check HBV also

Question 14

Treatment HCV - DAA

Answer 14

Check genotype

1. Protease inhibitors
   - Glecaprevir, Grazoprevir, Voxilaprevir
2. NS5A inhibitors **use for genotype 3
   - Elbasvir, Ledipasvir, Pibrentasvir, Velpatasvir
3. NS5B Polymerate inhibitors
   Sofosbuvir

Give combo therapy

Question 15

HCV DAA Drug interactions

Answer 15

CYPs especially:

1. PPI
2. Statin
3. Amiodarone
4. Antiepileptics

Question 16

DDA Absolute C/I

Answer 16

Amiodarone

Carbamazepine

Question 17

DDA Absolute C/I

Answer 17

Amiodarone

Carbamazepine