Hep A and B Learning Objectives (Barber)

- Fatigue / malaise

- Loss of appetite

- RUQ pain

- Myalgia / arthralgia

- Jaundice ± pruritus

- Dark urine / light stools

Shared Acute Symptoms (HAV & HBV)

- Fatigue

- Anxiety, anorexia

- Ascites

- Jaundice

- Variceal bleeding

- Hepatic encephalopathy

Chronic Symptoms (mainly HBV)

acute only (self-limiting)

HAV

acute or chronic

HBV

- RNA virus

- Replicates in hepatocyte cytoplasm

- Liver damage = immune-mediated (T cells, NK cells)

- Virus excreted in bile → stool

Hepatitis A (HAV) Pathophysiology

- 1.4 million cases worldwide annually

- Declined significantly due to vaccination

- Fecal-oral transmission

Hepatitis A (HAV) Epidemiology

- Person-to-person (household, sexual, daycare)

- Contaminated food/water

Hepatitis A (HAV) transmission

- Travel to endemic areas

- MSM

- IV drug use

- Chronic liver disease

- Occupational exposure

Hepatitis A (HAV) risk factors

- Double-stranded DNA virus

- Uses reverse transcriptase

- Integrates into host DNA

- Infects via surface antigen binding

Hepatitis B (HBV) pathophysiology

- 640,000 chronic infections in US

- 30% of infants → chronic vs <5% adults

- Highly infectious (50-100× HIV)

Hepatitis B (HBV) epidemiology

- Blood, serum, wound exudates

- Perinatal (mother → child)

- Sexual

- Needle sharing

Hepatitis B (HBV) transmission

- Multiple sexual partners

- IV drug use

- Healthcare exposure

- Dialysis

- Immunosuppression

Hepatitis B (HBV) risk factors

Acute infection

Anti-HAV IgM

Immunity (past infection or vaccine)

Anti-HAV IgG

Active infection

HBsAg

Immunity

Anti-HBs

Exposure

Anti-HBc

Acute infection

Anti-HBc IgM

have to know this

- Children (12-23 months)

- Unvaccinated (2-18 years)

- High-risk groups (travelers, MSM, drug use, etc.)

- Chronic liver disease, HIV, pregnancy

Hepatitis A Vaccine

2 doses

- Havrix

- Vaqta

- 2, 3, or 4 doses

- combo HAV + HBV

Twinrix

- All infants

- Unvaccinated <19

- Adults 19-59

- ≥60 with risk factors

Hepatitis B Vaccine

3 doses

- Engerix-B

- PreHevbrio

- Recombivax HB

2 doses

Heplisav-B

Pre- or post-exposure for high-risk patients

HAV

Post-exposure (e.g., needlestick, newborns)

HBV

- No specific antiviral therapy

- Supportive care only

- Avoid hepatotoxic drugs

- Vaccination

- Hand hygiene

- Safe food/water

- Monitoring Symptom resolution (most recover in 3–6 months)

Hepatitis A

- Suppress viral replication

- Prevent progression

- HBV DNA > 2,000 IU/mL

- ALT > 2× ULN

- Cirrhosis

Hepatitis B

- Tenofovir (TDF, TAF)

- Entecavir

First-Line Treatment

Pegylated interferon

Alternative Treatment

- HBV DNA

- Liver enzymes

- Kidney function

- Lactic acid (NRTIs)

Monitoring

- NRTIs: ≥4-5 years (sometimes lifelong)

- Interferon: ~48 weeks

Duration

- Promote vaccination

- Counsel on liver-toxic drugs

- Monitor drug interactions

- Encourage alcohol abstinence

Pharmacist Role