Module 3: Hepatitis Management

which HAV vaccines can be used alone?

Havrix or Vaqta

* 2 shots at 0 and 6 mo

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Name and vaccine schedule of HAV and HBV combined product?

* Name: Twinrix
* Dose: 0,**1**, 6 mo

→ can be abbreviated for travelers

Can Immune Globulin be used in BOTH pre and post-exposure

Yes

* Pre: for older adults, immunocompromised persons, persons with chronic liver disease going to high HAV region
* Post: within 14 days
* same criteria as pre
* addition to persons who is allergic to the vaccine or a vaccine component

Which HBV vaccine is given at 0 and 1mo?

HBV- CpG (Heplisav-B)

When should we treat chronic HBV?

1. ALT is elevated
2. HBV DNA is elevated
3. Liver histology: moderate to severe inflammation or fibrosis

regardless of the status of HBeAg

→ trx when pt is in immune active phase or immune reactivation phase

What is the most ideal treatment response measures for chronic HBV?

Loss of HBsAg

(NOT HB==e==Ag)

Which HBV drug is the most potent?

entecavir

What are endpoints for HBeAg (+) pts?

* trx at least a year (same with HBeAg negative)
* HBeAg conversion to anti-HBe (+)
* Undetectable HBV DNA
* Additional 6 mo of trx

==(not need 6 more mo for HBeAg NEGATIVE)==

which meds should we use for HBV if pt has NO co-infection with HIV?

Peginterferon

or Adefovir

which meds should we use for HBV if pt HAS co-infection with HIV?

Tenofovir as a backbone

* add Lamivudine or Emtricitabine

Is pt asymptomatic in early stage of HCV?

NO

→ pt will be asymptomatic until LATE stage

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Will HCV result in EXTRA-hepatic manifestations?

Yes

* problems with Cryoglobulinemia, Skin conditions, Insulin resistance, and TII DM, Lymphomas

Which HCV genotype is the most prevalent worldwide?

Genotype 1b

Virological response is clinical endpt?

NO

it’s a surrogate endpoint

how many weeks after we initial the HCV trx should we expect UNDETECTABLE viral load?

12 weeks

Virological relapse

End of trx response, but detectable viral load during 12 weeks **after trx ends**

Simplified Trx for HCV Trx Naive Pts w/out Cirrhosis

Adults with chronic HCV (any genotype) w/out cirrhosis and w/out previous trx

* NOT eligible:
* Prior HCV trx
* Cirrhosis
* HBV positive
* Currently pregnant
* Known or suspected HCC
* Prior liver transplant

Do we need to take Gleca/Pibrent with food?

Yes

* 8 weeks

How long do we use Sofos/Velpat for Naive, no cirrhosis?

12 weeks

Elbasvir/Grazoprevir can only be used for Genotype 1 and 4?

TRUE

→ not need renal adjustment

→ also shouldn’t use with any anti-HIV agents