Lecture 3 - Viral Hepatitis Flashcards
pl at risk of getting Hep C?
IV drug users
Ppl with HIV
anyone received blood before 1992
Healthcare professionals exposed
Liver disease symptoms
Babies of moms with it
anyone been to prison
anyone getting tattoo/piercing with dirty needles
HCV clinical presentation info
latency: 4-12 weeks
~ 30% have initial symptoms
ALT lvls may peak > 10 x ULN
15-50% of those infected will clear HCV
To diagnose someone with chronic HC you have to have….
presence of HCV-antibodies, HCV-RNA and have to be detectable at 2 different times atleast 6 months apart
Acute HCV treatment goals
no management options for it
Chronic HCV treatment goals
SVR: typically 12 weeks after treatment completion
Lack identifiable HCV-RNA at lvl > 15 IU/mL
Transaminase normalization
NS3/4A protease inhibitor MOA
inhibit replication of HCV via NS3/4A serine protease, blocks NS3 catalytic site and facilitates viral elimination
NS5B RNA dependent RNA polymerase inhibitor MOA
NS5B is necessary for replication of HCV and inhibition acts as a chain terminator
NS5A inhibitor MOA
NS5A involved in viral replication and assembly of HCV
NS3/4A drugs end in….
-previr
NS5B RNA dependent RNA polymerase inhibitors end in…
-buvir
NS5A inhibitors end in…
-asvir
Who eligible for HCV treatment? DDA regimens
18+ who have to previously been treated with HCV and don’t have cirrhosis
1st line HCV treatment therapies?
Mayvret X 8 weeks = Glecaprevir/pibrentasvir
Epclusa X 12weeks = Sofosbuvir/velpatasvir
Pediatric HCV management
Eligibility if 3-17 yrs old w/genotrypes 1,4,5 or 6-17 with any
Pediatric HCV treatment
Mayvret X 8 weeks = Glecaprevir/pibrentasvir
Epclusa X 12weeks = Sofosbuvir/velpatasvir
Harvoni X 12 weeks = Ledipasvir/Sofosbuvir
pediatric pts do have weight based dosing, reduced
CI of Mayvret (Glecaprevir/Pibrentasvir)
CI w/ atazanavir or rifampin
Avoid atorva/simvastatin, limit dose of rosuvastatin to 10
monitor if on Amiodarone for 2 weeks post initiation due to risk of fatal bradycardia
CI of Epclusa (sofosbuvir/Velpatasvir)
Limit dose of rosuvastatin 10mg, monitor all others
monitor if on Amiodarone for 2 weeks post initiation due to risk of fatal bradycardia
CI of Harvoni (Ledipasvir/Sofosbuvir)
Cardiac monitoring if on amiodarone
avoid concurrent use of acid suppression therapy…if cant then admin together or separate by 12hrs
avoid rosuvastatin, monitor all others***
What should Mayvret (Glecaprevir/Pibrentasvir) combo be avoided in
Dabigatran
Aliskiren
Atorva/Lova/Simvastatin
common limits for statins?
Atorva = 40mg
rosuvastatin = 10mg
Therapeutic monitoring for HCV treatment?
HCV RNA = if detectable or not at weeks 8,12,etc
detectable = fail
concern for Ribavirin therapy in females?
Teratogenicity
pregnant people and those trying to become pregnant atleast 6 months after stopping
Hep B pre-exposure prophylaxis
Vaccination
can be anywhere from 2-4 doses
anyone who doesn’t have it should get it
if get full course of vaccine and get exposed to someones Hep B blood then…
you’re gucci
if incomplete vaccine status and get exposed to someones Hep B blood then…
finish up vaccine series at schedules interval
get single dose HBIG = HB immunoglobulin
if unvaxxxed and get exposed to someones Hep B blood then…
you need vaccine within 12/24hrs or sooner.
also get single dose of HBIG = HB immunoglobulin
HBIG dose
0.6mL/KG IM for 1 dose
HBV vaccine
3 doses, 0/1/6 months
vaccines can be interchanged if necessary to complete series
1st dose should be given within 12/24hrs of exposure
should pts in immune active stage get treatment?
yup
Diagnosis of CHB
HBsAG + at least 6 months
detectable lvls of HBV DNA typically 2,000-20,000
ALT > 2X ULN
Monitoring HBV DNA treatment
Sustained virology response
HBeAG- = goal < 2000IU/mL, check every 3 months until undetectable then 3-6 months after
HBV viral relapse if…
> 2000 IU/,mL HBV DNA after being undetectable
Tenofovir info
MOA: inhibit reverse transcriptase, messes viral DNA
has greater resistance longer pt is on them
used as long as pt has HBV DNA
preferred in pregnancy
Interferon highlights
option for pediatric patients
usually for defined period of time, no more than 48 weeks
should you use combo therapy for HBV?
no
unless PegIFN + lamivudine
Hep A need to know
get vaccine
can give immune globulin depending on how long person traveling for to places with risk of Hep A
Post exposure Hep A treatment
1-40- yrs old, vaccine preferred
> 40 yrs old immune globulin > vaccine
if caught within 14 days
