EXAM 2- KUTZER - HEPATITIS

FOCUS ON BOLDED!!!!!!!

What type of virus is Hepatitis A? replication?

• non-enveloped RNA virus

• replication occurs in hepatocytes and GI epi cells

Who should receive a Hepatitis A vaccine?

• all children at 1 year of age

• unvaccinated children ages 2-18

• traveling/working with high infection rates

• persons at occupational risk

• anyone who want’s it!!!!!!!!

What are the names of the Hepatitis A vaccine?

• HAVRIX

• VAQTA

• TWINRIX (has Hep A and Hep B)

What is the name of the Hepatitis B vaccine?

• Engerix-B

• Recombivax

• Heplisav

• PreHevbrio

How do you interpret the serologic test results and the stage of Hepatitis B?

• specifically if the test is HBsAg negative

• FOCUS ON THISSSSSS ONEEEEEEEEEEEEEE

• HBsAg negative—>

  • susceptible to the virus

  • could also mean you had past Hep B infection, but it resolved

  • could also mean you’re vaccinated (if test is performed within 1-2m after 3rd dose of vaccine)

How do you interpret the serologic test results and the stage of Hepatitis B?

• HBsAg positive

• Anti-HBc

• (not that imp, focus on HBaAg negative)

• HBsAg positive

  • acute infection

  • chronic infection (HBsAg for more than 6m)

• Anti-HBc

  • means you have antibodies

Which hepatitis is often self-limiting and only an acute infection?

a. hepatitis A

b. hepatitis B

c. hepatitis C

a.

Know criteria for the treatment of Hepatitis B:

• anyone with active ____________________________

  • DNA level?

  • ALTs?

• anyone with compensated or decompensated _____________________

• family history of…

• prior history of…

• _______________ manifestation of HBV

• anyone with active HBV defined as HBsAg positive with HBeAg+ or HBeAg-

  • HBV DNA >2,000 IU/ml

  • ALT 2x upper limit of normal

• anyone with compensated/decompensated cirrhosis with any HBV DNA level

• family history of HCC or cirrhosis

• prior history of HBV tx

• extrahepatic manifestation of HBV

• (FYI: also to anyone that wants it)

What is the treatment dose of Entecavir?

• tx dose:

  • 0.5mg daily for adults with

    • tx naive

    • non-lamivudine resistant infection

  • 1mg daily

    • lamivudine experienced pts.

    • pts. with decompensated cirrhosis

Entecavir is not recommended in pts. with prior ____________ experience.

lamivudine

What’s the advantage of tenofovir AF over DF?

• AF has smaller changes in GFR

• AF has improved bone safety

• AF is delivered directly to the hepatocyte and an improved action against HPV replication

• in general: alafenamide has less side effects compared to diprovoxil

How is Hepatitis B treated in pregnancy?

What must the serologic tests be positive for?

• Tenofovir DF is recommended in 3rd trimester (NOTE: DF NOT AF)

• HBeAg positive and HBV DNA greater than 2,000 IU/ml

What type of virus is Hepatitis C?

single stranded RNA virus

Route of administration of DAA medications?

orally

What DAA covers all genotypes of Hepatitis C?

Glecaprevir/Pibrentasvir

What is the dose for Glecaprevir/Pibrentasvir for treatment of Hep C?

100mg/40mg

What are the doses of DAA for the treatment of Hepatitis C?

• glecaprevir/pibrentasvir (100mg/40mg)

• leedipasvir/sofobuvir (90mg/400mg)

• sofosbuvir/velpatasvir (400mg/100mg)

• elbasvir/grazoprevir (50mg/100mg)