Viral Hepatitis Flashcards
Transmission of Hep A
Fecal Oral
Transmission of Hep B
Parental
Sexual
Perinatal
HAV risk factors
Travelers to high risk countries/endemic areas
Contacts of recent international adoptees from HAV endemic countries
Household and sexual contacts
Men who have sex with men
Persons who inject drugs
work with HAV infected primates
Food outbreaks
HBV risk factors
Born to infected mothers
Multiple sex partners
STIs
MSM
IVDU
Household contacts
Healthcare workers, public safety workers, residents and staff of facilities for developmentally disabled persons
Hemodialysis
Travel to region with high prevalence of HBV
Healthcare-associated outbreaks
HCV risk factors
IVDU
MSM
STI
Blood transfusion
Needle stick injuries
Tattoos in nonregulated settings
Cirrhosis:
Detection use what?
Severity can be determined by what?
Compensated?
Decompensated?
US of liver; Blood tests
Child Turcotte Pugh score
Child Pugh A
Child Pugh B
Clinical Presentation of Viral Hepatitis Acute
Fever
Fatigue
Loss of appetite
Nausea
Vomiting
Abdominal Pain
Gray-colored bowel movements
Joint pain
Jaundice
Viral Hepatitis
VAH
Acute?
Immunity?
Total =?
Anti-HAV IgM
Anti-HAV Ab (or HAV Ab)
IgG + IgM
Viral Hepatitis
HBV
Immunity? (Vaccine) (Past Infection)?
Acute?
Chronic?
Infectious?
Anti-HBs (or HBsAb) (+) 10 mlU/mL; (HBcAb -); (HBcAb +)
HBsAg (+) and HBcAb (+) and HBcAb IgM (+)
HBsAg (+) and HBcAb (+) (total = IgG + IgM)
HBeAg (+) and HBV DNA (viral load)
Viral Hepatitis
HCV
Screen?
Chronic?
HCV Ab
HCV RNA (viral load) detectable x 6 mo
HBV DNA undetectable level = ?
HCV RNA undetectable level = ?
< 20
< 15
HBV status
HBsAg (Neg)
anti-HBc (Neg)
anti-HBs (Neg)
Susceptible
HBV status
HBsAg (Neg)
anti-HBc (Pos)
anti-HBs (POS)
Immune due to natural infection
HBV status
HBsAg (Neg)
anti-HBc (Neg)
anti-HBs (Pos)
Immune due to hepatitis B vaccination
HBV status
HBsAg (Pos)
anti-HBc (Pos)
IgM anti-HBc (Pos)
anti-HBs (Neg)
Acutely Infected
HBV status
HBsAg (Pos)
anti-HBc (Pos)
IgM anti-HBc (Neg)
anti-HBs (Neg)
Chronically Infected
HBV status
HBsAg (Neg)
anti-HBc (Pos)
anti-HBs (Neg)
Interpretation unclear; four possibilities
1. Resolved infection (most common)
2. False-positive anti-HBc, thus susceptible
3. “Low level” chronic infection
4. Resolving acute infection
Viral Hepatitis Acute Treatement
Supportive Care
Viral Hepatitis Chronic Treatment for which viruses?
Baseline testing includes what?
HBV; HCV
Viral load for HBV DNA; HCV RNA; HIV test prior to treating viral hepatitis
HBV Goals of Treatment
Suppress what?
Loss of what?
Prevent what?
HBV replication (HBV DNA undetectable; < 20 IU/mL)
HBsAg
Progression
Chronic HBV treatment Nucleoside/tide analogs
Disoproxil fumarate
Dose?
Adjustments for what/
Drug-drug interactions?
ADRs?
300mg PO daily
renal insufficiency
minimal
Nephrotoxicity (Monitor CrCl, serum phosphate, urine glucose and protein annually)
Decreased bone mineral density (consider BMD)
Chronic HBV treatment Nucleoside/tide analogs
Alafenadmide
Dose?
Avoid use if?
what type of substrate?
Active against what strains?
25mg PO daily
CrCl < 15
P-glycoprotein
Iamivudine-resistant
Chronic HBV treatment Nucleoside/tide analogs
Entecavir
Dose: Naive, Lamivudine-resistant HBV?
Adjust dose in what?
Drug-drug interactions?
Tolerated how?
Effective against what?
Naive: 0.5mg PO daily
Lamivudine-resistant HBV: 1mg by mouth once daily
Adjust in renal insufficiency
Minimal
Relatively well
Iamivudine-resistant HBV
Chronic HBV treatment Nucleoside/tide analogs
Lamivudine
Dose?
Adjust for what?
Tolerated how?
Drug-drug interactions?
High rates of what develop?
100mg PO daily
renal insufficiency
relatively well
minimal
resistance
Chronic HBV treatment Nucleoside/tide analogs
Telbivudine
Competitive inhibitor of what?
Dose?
Adjust in what?
ADRs?
High rates of what develop?
Cross-resistance with what?
It has an undefined what?
RT and DNA polymerase
600mg PO daily
renal insufficiency
Increased CK, myopathy, peripheral neuropathy
resistance
iamivudine
role
Chronic HBV treatment duration
HBeAg(+):
HBeAg(-):
6mo following HBeAg seroconversion and HBV DNA undetectable
indicates that HBV is in restful state. Occurs in acute hepatitis when antigen declines, virus becomes undetectable and HBeAB becomes (+)
HCV monitoring
How often?
What labs?
Goal?
4 weeks and completion of therapy
CMP, CBC, HCV RNA
cure = sustained virological response (SVR), HCV RNA < 15
Viral Hepatitis Non-pharmacological treatment
Avoid what?
Vaccinate against what?
What are risk factors for progression of HCV?
alcohol
HAV and HBV as appropriate
obesity, tobacco smoking, and marijuana
Viral Hepatitis Prevention
Pharmacological?
NonPharmacological:
HAV?
HBV?
HCV?
Occupational?
Vaccine: HAV HBV
Handwashing
none
Do not share razors or toothbrushes
standard precautions
HAV Vaccine Adult Recommended for the following populations?
Chronic liver dz
Clotting factor dz
MSM
Drug Use
Homelessness
Work with HAV in research lab or with infected nonhuman primates
Travelers to countries with intermediate to high endemic HAV
Close personal contact with international adoptee arriving from intermediate to high endemic with HAV
HBV Vaccine Adult Recommended for the following populations?
HCV
Chronic liver dz
HIV
Sexual exposure risk, partner (MSM, STI, not in mutually monogamous relationship)
Current or past injection drug use
incarcerated
travelers to countries with intermediate to high endemic HBV
DM
