Therapeutics of Viral Hepatitis

Question 1

Signs and Symptoms of Acute Hepatitis

Answer 1

May be asymptomatic
Flu-like
Skin rash
Jaundice
Light colored stool
Dark urin

Question 2

Signs and symptoms of Chronic Hepatitis

Answer 2

Infections present for more than 6 months
Asymptomatic
Malase or fatigue
Can progress to cirrhosis (liver failure)
At risk for liver cancer

Question 3

HAV

Answer 3

It is preventable and you rarely see it any more

Question 4

HBsAg

Answer 4

Hep B Surface antigen
Persistence for greater than 6 months = chronic infection
DO YOU HAVE THE VIRUS?

Question 5

HBeAg

Answer 5

Indicates active replicating virus

IS IT ACTIVE?

Question 6

HBV DNA

Answer 6

Actual level of virus

HOW MUCH OF THE VIRUS DO YOU HAVE?

Question 7

Antigens vs Antibodies

Answer 7

Antigens are produced by the virus and antibodies are produced by your body

Question 8

Anti-HBS or HBsAb

Answer 8

Antibody to hepatitis B surface antigen

Have it because you had it and recovered and have immunity OR you were vaccinated

Question 9

AntiHBc or HBcAb

Answer 9

Antibody to hepatitis B core antigen
Previous or ongoing infection
Occurs at the onset of infection and last for life

Question 10

Anti-HBe or HBeAb

Answer 10

Antibody to Hep Be antigen
Lower level of viral replication
- NO REPLICATION

Question 11

Seroconversion

Answer 11

Has a positive antigen (replication) and now have positive antibody (no replication

Question 12

HBsAB (-) + HBsAG (-)

Answer 12

Patient needs vaccination but doesnt have HBV

Question 13

HBsAb (+) + HBsAg (-)

Answer 13

Patient is immune either through vaccine or previously cleared infection
No active disease

Question 14

HBsAb (-) + HBsAg (+)

Answer 14

Patient has HBV and if this has been positive for more than 6 months then it is chronic HBV

Question 15

Hep A Vaccine Schedule

Answer 15

Month 0 and month 6

Question 16

Hep B Vaccine Schedule

Answer 16

Month 0, month 1, and month 7

Question 17

HBV Post Exposure

Answer 17

Give both Immune globulin + HBV seizures

Question 18

Chronic Hepatitis B

Answer 18

HBsAg positive for more than 6 months

Question 19

Goals of Hep B Treatment

Answer 19

Viral suppression (undetectable HBV DNA)
Seroconversion (positive eAg to positive eAb)
Loss of HBsAg
Prevent cirrhosis, hepatic failure and HCC

Question 20

Elevated HBV DNA Levels

Answer 20

HBeAg(+) + Greater than or equal to 20,000 or 10^5 copies/mL

HBeAg(-) + Greater than or equal to 2000 or 10^4 copies/mL

Question 21

When to treat?

Answer 21

Elevated HBV DNA levels + Elevated ALT more than 2 times ULN (30 in men, 19 in women) OR moderate/advance liver disease on biopsy

Question 22

1st Line Treatment Options

Answer 22

Tenofovir, entecavir or peginterferon (SC weekly)

Question 23

Chronic Treatment Duration

Answer 23

48 weeks with either PegIFN or nucleotide analogs (PO)

Question 24

Discontinue antiviral therapy

Answer 24

HBsAg loss or HBeAg seroconversion on 2 separate at least 6-12 months apart

Question 25

Once you achieve seroconversion, you continue treating for

Answer 25

AT least 6 months to prevent flare or relapse

Question 26

PegIFN Alfa-2a brand and dose

Answer 26

Pegasys
Given weekly SQ for 48 weeks
ONLY Injection

Question 27

PegIFN Alfa-2a CI and Tolerance

Answer 27

Liver failure and pregnancy

Lost of SE so you feel crummy the whole time you take it

Question 28

Nucleos(t)ide Analogues Drugs

Answer 28

Tenofovir

Entecavir

Question 29

Nucleos(t)ide Analogues Drugs Problems

Answer 29

May cause lactic acidosis

Rapid increase in ALT or acidosis = d/c

Question 30

Routine Care for Chronic HBV

Answer 30

Vacciante
Screen for HIV or HCV
Evaluate LFTs and HBV DNA levels every 3-6 months
Screen for cancer
Evaluate need for antiviral
Check resisitance

Question 31

HBV Patient Education

Answer 31

Avoid alcohol and hepatoxins (APAP greater than 2 g)

Reduce risk of transmission and get vaccinated

Question 32

*****IFN Requirements

Answer 32

ALT > 100 and HBV DNA less than 10^7