Viral Hepatitis

Question 1

in what pt population is sofosbuvir not approved?

Answer 1

CKD4-5 or those on hemodialysis

Question 2

define co-infection of Hep D w/ HBV vs superinfection of hep D w/ HBV

Answer 2

co-infection:
when infection w/ the delta virus happens at the same time as HBV infxn

superinfection:
when infection w/ delta virus happens AFTER HBV infxn

Question 3

in what context of HBV is tx w/ interferon contraindicated?

Answer 3

if pt is in decompensated liver disease, interferon is contraindicated for tx of HBV

Question 4

age to start screening for HCC for non-cirrhotic Asian females w/ chronic HBV?

Answer 4

age 50

Question 5

what is a contraindication of using NS5A inhibitors such as velpatasvir and ledipasvir for HCV tx?

Answer 5

concomitant use of PPI’s.

solubility of velpatasvir and ledipasvir decreases as pH increases

sofosbuvir/ledipasvir can be taken simultaneously under fasted conditions with any PPI at a dose comparable to or lower than omeprazole 20mg.

antacids should be avoided within 4 hrs of sofosbuvir/ledipasvir or sofosbuvir/velpatasvir use.

H2RA should be taken simultaneously or 12hrs apart

Question 6

who gets chronic hep E? what is the best tx?

Answer 6

solid organ transplant recipients may get chronic hep E, best treated with ribavirin

Question 7

True or False. pt’s previously exposed to hep B should get immunoprophylaxis prior to chemotherapy

Answer 7

True.

Pt’s w/ prior hep B exposure (sAg - / cAb+ / sAb+)

Question 8

A patient taking which medication should not be on a sofosbuvir-containing HCV tx regimen?

Answer 8

amiodarone + sofosbuvir can cause significant bradycardia.

Question 9

A patient taking which medication should not be on gecaprevir/pibrentasvir?

Answer 9

statins + glecaprevir/pibrentasvir has increased risk of rhabdomyolysis.