Treatment of chronic hepatitis Flashcards
Presence of HBeAg
high viral load
Presence of HBeAb
lower viral load
Presence of HBV DNA
active viral replication
Goal of HBV treatment
HBeAg seroconversion to HBeAb, negative HBV DNA
prevention of decompensated cirrhosis in chronic disease
Indications for treatment of chronic HBV infection
HBsAG (+) > 6mo
High HBV DNA
Persistent/intermittent elevation in ALT and AST
Treatment options for HBV
Interferons (more durable response, no resistant mutants), nucleoside/tide analogs (fewer side effects, resistant mutations)
Goal of HCV treatment
clear HCV RNA. remain negative 12 weeks after stopping therapy –> cure
Treatment of HCV genotypes 2 and 3
sofosbuvir + ribavirin
Treatment of HCV genotype 1
sofosbuvir + ledipasvir
treatment naive w/wo cirrhosis: 8-12 weeks
Treatment experienced w/o cirrhosis: 12 weeks
Treatment experienced w/ cirrhosis: 24 weeks
Treatment of hereditary hemochromatosis
therapeutic phlebotomy. 500 ml of whole blood = 200-250 mg Fe
endpoint in serum ferritin = 50-100 ng/ml
anemic patients: desfuroxamine chelation
Treatment of autoimmune hepatitis
corticosteroids, azathioprine –> immune suppression
Primary biliary cirrhosis
immune mediated disease –> damage to small intrahepatic bile ducts
strongly positive anti-mitochondrial antibody
Treatment of primary biliary cirrhosis
ursodeoxycolic acid
Treatment of Primary sclerosing Cholangitis
no effective medical therapy. Treat complications: stent for strictures, antibiotics for cholangitis
Treatment of Wilson disease
copper chelation (D-penicillamine, Trientine)
zinc maintenance therapy
