Viral hepatitis

Question 1

First line treatment for all HCV types?

Answer 1

sofosbuvir/velpatasvir (epclusia)

Glecaprevir/pibrentasvir (Mavyret)

Question 2

If relapse after sofosbuvir/ledipasvir, treat with?

Answer 2

Sofosbuvir/Velpatasvir/Voxilaprevir

Question 3

Sofosbuvir/Ledipasvir combinations are only approved for

Answer 3

genotypes 1 and 4.

Question 4

Groups who should not be given sofosbuvir/velpatasvir or Glecaprevir/pibrentasvir?

Answer 4

HCC
HIV
ERSD
Pregnant
Prior OLT

Question 5

in ESRD patients, avoid this HCV drug?

Answer 5

Sofosbuvir

Question 6

Treatment for infant with HBV+ mother?

Answer 6

both hepatitis B immune globulin and vaccination

Question 7

Duration of HCV treatment in patients with cirrhosis?

Answer 7

12 weeks

Question 8

When to initiate therapy to a HBV+ mother?

Therapy of choice?

Answer 8

Viral load >200,000

Tenofovir

Question 9

Liver biopsy shows “ballooning hepatocytes” - concerning for?

Answer 9

NASH

Question 10

UGT1A1 genotype is the genetic test for?

important for patients who receive?

Answer 10

Gilbert’s syndrome;

iranotecan based chemotherapy

Question 11

immune tolerant phase of HBV?

immune reactive (immune clearance) phase?

inactive carrier state?

pre-core mutant hepatitis?

Answer 11

high HBV DNA for the first 20-30 years of life with normal LFTs

sharp spike in the ALT and the HBV DNA may decline +/- seroconversion from HBeAg to HBeAb

after the seroconversion to HBeAb and is notable for low DNA levels and relatively normal LFT’s

HBeAg (-) chronic hepatitis

Question 12

Decision to treat HBV?

Answer 12

Immune Reactive or HBeAg negative reactive stages (when transaminases are elevated)

Question 13

HBV medication with best opportunity for HBeAg seroconversion?

Best medication for viral supression?

Answer 13

Interferon

Nucleosidase/tide agents

Question 14

Only hepatitis that doesn’t have a vaccine?

Answer 14

HCV

Question 15

Which hepatitis is associated with porphyria? (which porphyria?)

Answer 15

hCv -> pCt (porphyria cutanea tarda)

Question 16

Contraindications to Interferon?

Answer 16

Hepatic decompensation
History of organ transplant
retinopathy
bipolar
ACS
PLT<50

Question 17

what patients are at risk for HBV reverse seroconversion? Require?
(These GI medications do not qualify?)

Answer 17

Under bimodal B and T cell immunosuppression; Entecavir

(TNF-a agents)

Question 18

When to treat for prophylaxis against HBV seroconversion for chemo patient?

Answer 18

During chemo and 12-18 months after

Question 19

Concurrent HCV and HBV management?

Answer 19

-If HBV load >20,000, treat both
-Otherwise, monitor and treat if HBV load increased by 10x (or 1000 if from undetectable)

Question 20

Prophylaxis for HBsAg- negative/anti-HBc+ patient getting prednisone? for how long?

Answer 20

Tenofovir; 6 months after stopping prednisone

Question 21

Mixed Cryoglobulinema presents with? Labs?

If significant end-organ damage, treatment?

Answer 21

purpura, arthralgias, and weakness;

UA/renal insufficiency

rituximab

Question 22

Class of HCV drugs not approved for decompensated cirrhosis?

Answer 22

protease inhibitors (-previr)

Question 23

IVIG - effect on HBV serologies?

Answer 23

False+ HBcAb