Viral Hep Flashcards
Jaundice and increas serum ATL are part of whihc hep
acute
liver cirrhosis and complications of ESLD are part of whihc hep
chronic
whihc hep has no treament?
a
whihc hep can u be immunized for
hep a and b
whihc hep has transmission via percutanoues, sexual and perinatal
B and D
whihc hep has a dna virus
B
whihc hep has insidious onset verusus sudden
B, C, D
whihc hep has a chornic conponent/whihc has the largest chronic conpentent?
B, C, D
C (70-80%), B (9-10% inaudlts, 90% in children), D
antigen and antibody for HAV
Antigen: hep a virus
Antibody: hep A antibody ( Anti-HAV)
antigen and antibody for HBV
Antigen: HBsAb, HBcAg, HBeAg (surface core envelop)
Antibody: anti-HBs, anti-HBc (IgM- acute infection, IgG- chronic or recovery) , anti-HBe
whihc antigen is not measure for hep b
core
antigen and antibody for HCV
Antigen: HCV
Antibody: anti-HCV
following percutaneous needle injury what are you likely to get?
HIV, HCV, HBV
whihc hep can be cured?
C
Timeline of incubation, symptoms, infectivity and resoltion for hep A
Incubates: 28 days
Symptoms: children can be asymptomatic
infectivity: 2 weeks before symx
resolution: 2 months (up to 6 months)
how does perinatal transmission occur and how should we treat it? What can mom do to prevnt it
mother is HBsAg positive at time of delivery
TX: HBIg and hep b vax to child within 12 hours of delivery and revax at 1 and 6 months ( reduces transimmison from 90% to 10%)
prvention: in third trimester mother can take nucleotide to reduce viremia (TDF)
HBV post-exposure if HBsAg positive, known non-responder
IG and initiate vx series
HBV post-exposure if HBsAg positive, and antibody response unknown
test exposed person for anti-HHs, if inadequate response treat as non-responder
clinical progression of Hep b
acute - chronic - cirrhosis (liver failure - decompensated, or liver cancer) - liver transplant and death
HBsAg: negative
Anti-HBc: negative
Anti-HBs: negative
susceptible to virus
HBsAg: negative
Anti-HBc: Positive
Anti-HBs: positive
immune due to natural infection
HBsAg: negative
Anti-HBc: negative
Anti-HBs: positive
immune due to hep b vax
HBsAg: pos
Anti-HBc: pos
IgM anti-HBc: pos
Anti-HBs: negative
acutely infected
HBsAg: pos
Anti-HBc: pos
IgM anti-HBc: neg
Anti-HBs: negative
chronically infected
can hep b be cured?
not cured but controlled
duration of hep infection?
over 6 months
non-param for hep B and c
- reudce weight if BMI >30
- control sugars in DM
- reduce hepatoxins (alcohol, acetaminophen, herbal products)
- avoid NSADIS
- reduce risk of transmission
cover scrapes and cuts and bleach staidn
hep b: if Alt is normal
no tx, unless signifianct disease suspected
hep B : if alt is elevated and HBV DNA is 10 000- 10 000 000
consider pegiterferon or nuclos(t)ide analogues (entecavir, TDF, TAF), goals suppress HBe seroconversion
hep B : if alt is fluctuates and HBV DNA is 10 000- 10 000 000
nuclos(t)ide analohgues (entecavir, TDF and TAF) lifelong
hep B : if alt is elevated and HBV DNA is >100
nucleos(t)ide analog plus HBIg
Interferon when best to use and for long long?
low effeicay when DNA is high and low AST, can be used when DNA is low however more serious effects
only works for 24-48 weeks, consider therpay for 16-48 weeks
oral nucelosides inhibtiors used when, for how long, resistance and different types
- longterm suppressive therapy
- consider d/c after 12 months
Peginterferon : 180 mcg sq once weekly
entecavir : 0.5 mg Po daily: treamnt naive OR 1mg PO once daily : lamivudine resistance
TDF : 300 mg PO daily
TAF : 25 mg PO daily
hep B if treament naive:
Tenofovir or entecavir ( high genetic barrier to resistance )
- lamivudone - reisitance easier but can use entecavir then
If hep B and HIV co-infection
TDF and 3TC (emtricitabine) - if we d/c this it can cause flare up and decompensation
s/E /CI of Peginterferon
CI:
- major depressive order
- autoimmune
- cardiac
- decompensated cirrhosis
uncontrolled seizure disorder
S/E entecavir
take on empty stomach
TDF caution point
don’t use in renal insufficiency
TAF caution point
can be used in patients with renal insufficiency until CrCl ,< 15 mL/min
hep b monitoring
HBV DNA - q 3-6 months until undetable
ALT: q 3 mo nths
serology - surface, and envelope for q 6months on tx and d/c12-18 after treament
hep C risk factors
sexual activity : MSM, STI
Hep C testing
check if anti-HCV first then HCV RNA
hep c clinical progression
acute - chronic - cirrhosis - HCC transplant and death
what’s defined as a cure for hep C
undetecable viral load
hep c tretament options
DAAs for 8-12 weeks
+/- ribavirin (added for treament expected or decomp liver)
hep c tx for treatment experienced or decompensated cirrhosis
+/- ribavirin (added for treament expected or decomp liver)
first line for hep c
alsways 2 DAAs
the two DAA regimens
epclusa - sofosubuvir and velpatasvir
maviret - glecaprevir and pilbentasvir
epclusa duration/ special diet?
12 weeks - no speial diets
maviret duration/ special diet?
8 weeks - taken with food
who is eleigible for simplfied tretament
adults with chornic hep c , who do not have cirrhosis, and no previous hep c trtemant
epclusa - sofosbuvir/velpatatsvir drug class
NS5A inhib
epclusa - sofosbuvir/velpatatsvir AE
fatigue and headache
maviret - glecaprevir /pibrentasvir drug class
GLE: NS3/4a portetase inhibitor and pib:NS5A inhib
maviret - glecaprevir /pibrentasvir AE
Fatigue, headche, diaarrhea, nausea, prurirtus
DI with epclusa
Statins
PPI
H2RA
Anatcids
Amiodarone
HIV - Efavirenz, TDF
DI with maviret
Statin
Ethinyl estradiol
PPI
HIV - Efavirenze, draunavir/lopinavir/ritonavir, rilpivirine
HCV therpay caution points
HBV can be reactivated
when should protease inhibtors be avoided?
such as maviret
- ajundice, hepatic decomp, ascites, esophageal varicela hemorahge, hepatic encephalophathy
moniotrng and lab values need to be checked before starting theroay
HCV RNA, LFT, SCr, CBC
HCV ressitance testing
HBV (HBsAg)
efficacy tetsing
HCV RNA 12 weeks after completemnt of therpay
If hep B coinfection what shoudl we do
give them hep b therpy fro 12 weeks
