Tx for Viral Hepatitis Flashcards
what are the goals of chronic HBV treatment
suppression of HBV DNA to undetectable levels
seroconversion of HBeAg from + –> -
reduce AST/ALT
what are the endpoints that correlate w/ the goals of chronic HBV Tx
improvement in necro-inflam dz
decreased risk of HCC & cirrhosis
decrease need for liver transplant
how is the HBV tx diff from HCV
cure is rare (cure is common in HCV)
in HBV tx - replication is suppressed w/o eradicating the virus
covalently closed circular vrial DNA in stable form is indefinitely w/i the cell = reservior for HBV throughout life –> capacity to reactivate
*relapse is more common if co-infected w/ HDV
what are the drugs used for chronic HBV and what are the respective adverse effects
Entecavir:
type?
indication?
adverse effect?
BB-warning?
=HBV nucleoside analogue reverse transcriptase
- chronic HBV in adults & kinds (>= 2 yo) w/ active viral replication OR persistent elevation in ALT/AST OR histologically active
MC rxn = HA, fatigue, dizzy, nausea
BB warning: severe acute post-Tx exacerbation, pt co-infected w/ HIV & HBC - Lactic acidosis and hepatomeg
Tenofovir Disoproxil
type
indications
adverse effect
BB warning
neucleotide analog HIV-1 RT (-) and HBV RT (-)
use w/ other antiretroviral agent to Tx HIV-1 infxn in adults and kinds (>= 2 yo)
pt w/ compenstated liver dx - MC rxn = nausea
BB: post-tx exacerbation of hep, lactic acidosis/severe hepatomeg w/ steatosis
what is the warning/precaution for tenofovir disoproxil use
new onset or worsen renal impairment
(acute renal failure & Fancomi syndrome)
Adefovir
type
indication
contraindication
adverse rxn
nucleotide analoug
chronic HBV in pt >= 12 to
DO NOT give to pt w/ previous hypersensitivity to any of its components
rxn= in compensated dz pt = asthenia, increased CK in pre/post transplantation lamivudin-resistant liver dz pts
what are the warning/precautions for adefovir use
nephrotoxicity - monitor renal fxn during use (in all pt but esp in pt w/ pre-existing risk of renal impairment)
severe acute exacerbation of hep
what are the drug interxns for adefovir
coadmin w/ drugs that decrease renal fxn or compete for active tubulr secretion can cause increase concentration of adefovir or coadministered drug
lamivudine
type
indication
contraindication
adverse rxn
nucleoside analogue RT (-)
combo w/ other antiretroviral agent for HIV-1 tx
DO NOT use if hypersensitive to lamivudine
MC rxn in adults = HA, nausea, malasie/fatigue, nasal sign/symp, diarrhea, cough
what are the warnings/precautions for lamivudine
in coinfected pt (HIV/HBV) - can get lamivudine resistant HBV
pancreatitis
Telibivudine
type
indication
contraindication
adverse rxn
nucleoside analogue RT (-)
chronic HBV in adults w/ viral replication and either persistent elevation of AST/ALT or histologically active dz
DO NOT: combo this w/ PEGylated IFN a2a –> increased risk for peripheral neuropathy
MC rxn - fatigue, increase CK, HA, cough, diarrhea, abd pain/distention, nausea, arthralgia, pyrexia, rash, back pain, dizzy, myalgia, ALT increased, dyspepsia, insomnia
PEG IFN a2a
indication
contraindication
adverse rxn
chronic HCV w/ compensated liver dz NOT previously treated w/ IFN-a
in pt w/ histo evidence of cirrhosis & compensated liver dz
&&& chronic HBV w/ compensated liver dz and evidence of viral replication/liver inflam
NOT for: AIH, hepatic decompensation in pt w/ cirrhosis & neonates/infants
MC rxn: fatigue/asthenia, pyrexia, myalgia and HA
what is the goal of HCV treatment
viral eradication
sustained viral response (SVR): absence of detectable virema 24 wks after completion of therapy
SVR -associated w/ improvement in liver histo, reduction in rsk of end stage liver dz, HCC and regression of cirrhosis (late relapse <5% pt who achieve SVR)
what direct acting antiviral combos are used for chronic HCV w/o cirrhosis
what are their side effects
