Viral Hepatitis Flashcards
transmission of hep A
fecal-oral
transmission of Hep B
blood
sexual
perinatal
is Hep B spread through food, coughing, touching?
no
hep C transmission
blood
risk factors for Hep A
direct contact with infected person
risk factor for hep B
born to infected mother
risk factor for hep c
injection drug use
potential for chronic infection hep a, b ,c
a - no chronic
b - acute then chronic depending on age
c - acute then 50% will get chronic
single greatest risk factor for chronic infection
age
90% of infants infected will get it
prevention of Hep B
screen all adults 18+ at least once in their lifetime with triple panel test, screen during each pregnancy
HBsAg on triple panel test is what
hep B surface antigen
if positive then patient has infection presently
anti-HBs on triple panel is what
antibody to hepatitis B surface antigen
shows if patient is immune
anti-HBc
antibody to hep B core antigen
shows if patient was exposed ever
IgM anti-HBc means what
immunoglobulin M class of antibody to hepatitis B core antigen
shows if patient was infected recently or exposed within past 6 months
HBsAg -
anti-HBs +
antiHBc +
resolved infection
counsel about reactivation
HBsAg -
anti-HBs +
antiHBc -
immune from vaccination
vaccinate if not completed series
HBsAg +
anti-HBs -
antiHBc +
IgM anti-HBc +
acute infection
give care
HBsAg +
anti-HBs -
antiHBc +
IgM-anti HBc -
chronic infection
link to care
hep B goals of therapy
achieve sustained suppression of HBV replication
remission liver disease
prevent cirrhosis, hepatic failure, HCC
HBsAg loss maybe
anti-HBe gain
goals of therapy hep C
obtain virological cure by achieving a sustained virological response (SVR)
- 12 weeks after completion of therapy re-test viral load and if undetectable than sustained
does treatment for Hep B cure?
no not completely
is combination therapy used in hep B?
no!
how long is therapy in hep B
indefinite usually
how did we used to do hep c therapy
interferon + ribavarin
do we use combination therapy in hep c
yes!
who should get treatemnt in hep C?
everyone infected unless <12 months left due to another disease
risk with hep c drugs
hep B reactivation
treatment eligibility in general for hep b
ALT > 2xULN or cirrhosis
HBV DNA > 2,000 IU/mL
ULN for ALT males and females
35 U/L in males
25 U/L in females
e+ immune tolerant
normal ALT
elevated HBV DNA++++
monitor
e+ immune active
elevated ALT
elevated HBV DNA +++
if ALT > 2x ULN and
HBV DNA > 20,000 IU/mL
then initiate treatment
e+ cirrhosis
elevated ALT
elevated HBV DNA ++
low albumin, low platelets
if HBV DNA >2,000 IU/mL initiate treatment
e- inactive (carrier)
normal ALT
low/undetectable HBV DNA +/-
monitor
e- immune reactivation
elevated ALT
elevated HBV DNA +++
if ALT > 2xULN and
HBV DNA > 2,000 IU/mL treat indefinitely
e- cirrhosis
ALT elevated
elevated HBV DNA++
low albumin, low platelets
if HBV DNA >2,000 IU/mL treat indefinitely
HBV treatment options
tenofovir (TDF): 300 mg PO daily
tenofovir (TAF): 25 mg PO daily
entecavir: 0.5 mg PO daily if naive, 1 mg PO daily if exper on empty stomach
peginterferon alfa: 180 mcg subq weekly x 48 weeks
monitoring for Hep B treatment immune tolerant
ALT q3-6 months
eAg q6-12 months
monitoring for hep B e- inactive
ALT q6-12 months
monitoring for Hep B pts on therapy
HBV DNA q 3 months until undetectable then q3-6 months after
monitoring for hep B in pts that have stoppped therapy
q3 months x 1 year looking for increased viral load, ALT flare, eAg
who should get HCC monitoring
HBsAt+ patients with cirrhosis and
first degree relative with it
asian/black men over 40
asian women over 50
every 6 months
pregnant women treatment with nucleoside analogs
if 28-32 weeks and HBV DNA >200,000 use tenofovir DF
patient with HIV and HBV should get what
three drug therapy
how long is hep C treatment
12 weeks usually
monitoring for patients with hep C
hypoglycemia if diabetes
INR if on warfarin
LFTs if cirrhosis
post treatment monitoring hep C
HCV RNA 12 weeks after to check for SVR
adverse effectes peg interferon alfa
flu like symptoms
fatigue
mood changes
autoimmune disease
anorexia
(bad side effects)
adverse effects entecavir
lactic acidosis
adverse effects tenofovir DF
nephropathy
Fanconi syndrome
osteomalacia
lactic acidosis
adverse effects tenofovir AF
lactic acidosis
adverse effects ribavarin
hemolytic anemia!!
pancreatitis
pulmonary dysfunction
insomnia
pruritis
teratogenic
CrCl < 50 contraindicated
hep C guidelines are where
hcvguidelines.org
-previr drugs class
NS3/4A protease inhibitors
-buvir drug class
NS5B polymerase inhibitors
-asvir drugs class
NS5A replication complex inhibitors
pre treatment testing for elbasvir
genotype test for patients with genotype 1A to screen for resistant substitutions
which Hep c drugs require pre testiing
elbasvir
velpatasvir
grazoprevir
pre treatment testing for velpatasvir
NS5A genotype performed in patients with genotype 3 to screen for Y93H substitution
grazoprevir on treatment monitoring
ALT checked at 8 weeks
d/c if > 5x ULN
