Hepatitis B Tx

Question 1

HIV co-infection

Answer 1

Tenofavir plus emtricitabine or lamivudine

Question 2

Tx of choice in decompensated liver failure?

Answer 2

Entacavir

Tenofavir may used used

Question 3

Tx of choice in renal insufficiency?

Answer 3

Entacavir preferred with dose modifaction

Question 4

Tx of choice in woman of child bearing age planning pregnancy in near term?

Answer 4

Tenofavir

Question 5

Tx of choice in female wishing to erradicate virus prior to pregnancy>

Answer 5

Interferon

Question 6

1st line Tx?

Answer 6

Entacavir (may be indefinite) or
Tenofavir (may be indefinite) or
PEG interferon for 48 weeks

Question 7

What is the recommendation for a pt deisring pregnancy who is HBV infected?

Answer 7

Mild liver disease and low viraemia
- pregnancy before Tx
Moderate liver disease, no cirrhosis
- Tx before preg, if response, stop Tx before pregnancy
Woman with advanced liver disease
- Tx before and during pregnancy and continue Tx after delivery
Woman with mild liver disease, very high viraemia?
- Tx in last trimester with Tenofavir. Discontinue post partum.

Question 8

HBV reactivation during CTx (HBV dna and increased ALT). Tx?

Answer 8

Prophylactic antiviral therapy at onset of chemotherapy or immunosuppresive therapy.
If baseline HBV DNA 2000 IU/ml, continue until target end pitns reached.

Tenofavir or entecavir preferred.

Question 9

What is the most common cause of abnormal LFTS?

Answer 9

NAFLD

Question 10

What is the main RF for NASH?

Answer 10

Visceral fat/obesity

Question 11

Adiponectin is reduced in obesity and pts with heaptic steatosis or NASH. T/F

Answer 11

True

Question 12

Most common cause of HCC?

Answer 12

Hep B

Question 13

Which drug has resistance associated?

Answer 13

Entecavir and Lamivudine
When switching or adding drugs, use Tenofavir/Adepavir instead if pt has had previous resistance to Lamivudine (same class as Tenofavir)

Question 14

E antigen associations?

Answer 14

Higher risk of developing HCC

Aim to:
Normalise ALT
PCR -ve
Surface antigen loss - hardest goal to reach 
prevent cirrhosis

Question 15

Risk associations if Hep B

Answer 15

More likely to develop chronicity.
Do not show signs of jaundice etc as too young to develop immune response to infection.

Worse prognosis than if you develop Hep B after 5 y

Question 16

Which of the Hep drugs is more effective at clearing

Answer 16

Tenofavir and Entacavir

Lamivudine no longer used due to resistance (YMDD mutation)

Question 17

Hep B screening. Who and when?

Answer 17

Screen every 6 months with US +/- AFP.
Screen:
Cirrhosis
Asian male

Question 18

Interferon. Benefits and cons?

Answer 18

Higher rates of e-antigen loss and surface antigen loss (25%) compared with nucleotides.

Finite course, use in pts who want to clear virus

Cons:
Psychiatric illness
Do not give in cirrhosis - causes ALT flares

Question 19

If you would like to suppress virus quickly?

Answer 19

Entacavir and Tenofavir if higher rates of suppressing virus quickly

Question 20

You have to have cirrhosis to develop hcc?

Answer 20

No

Hep B virus is an oncogene