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51 Cards in this Set
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- Back
- 3rd side (hint)
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rapid viral response
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undetectable viral load at 4 weeks
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early viral response
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undetectable viral load at 12 weeks
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sustained viral response
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undetectable viral load 24 weeks after therapy completion
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Hep C transmission
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percutaneous exposure to blood
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iv drugs, blood transfusion, needle sticks, dialysis patients, male to male sex
-contamination of drug paraphemalia, sex transmission occurs, but efficiency is low. |
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Hep C symptoms
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80% are considered asymptomatic and do not receive treatment
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Hepatitis C
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HCVRNA: detects qualitiative circulating RNA.
Genotype: helps to choose a therapy RT-PCR/bDNA: viral load testing |
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Genotype 1
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70% and more resistant
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- peg interferon and weight based dose of ribavirin
-peg interferon weekly -1000-1200 mg QD of ribavirin (75kg) -boceprevir 800mgTID or Telaprevir 750mg TID (direct-acting antiviral |
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Genotype 2 and 3
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easier to treat
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-weekly peg interferon weekly
-ribavirin 400mg BID -treatment for 24 weeks |
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Genotype 4
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like Genotype 1, it will be longer treatment
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-weekly peg interferon
-1000-1200 mg QD of ribavirin (75) -therapy for 48 weeks |
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Genotype 5 and 6
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rare
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6: weekly peg interferon
-ribavirin 400mg BID - therapy for 48 weeks |
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Factors that effect therapy
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age: younger is better
cirrhosis: worse prognosis race: black is worse obese: worse immune: poor immune function worse presence of IL28B CC genotype:better |
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When to treat HCV
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-persistently increased ALT
-detectable HCV RNA -liver byopsy: fibrosis, moderate inflammation and necrosis |
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Boceprevir brand
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Victrelis
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-4 tablets (800mg) TID
-with light snack -4 week lead in -32 week treatment -cyp3A4 |
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Telaprevir brand
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Incivek
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-2 tablets TID (750mg)
-with fat meals -12 week regimen (no lead in) -cyp 450 3A4 |
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Interferon ADR
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-neuropsychiatric (depression, suicide)
-hypersensitivity rxn -flu-like symptoms, weight loss, hypotension, bone marrow depression, autoimmune, colitis, pancreatitis |
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Ribavirin ADR
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-bone marrow suppression (neutropenia and anemia)
-NVD -additive mitochondrial toxicity |
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Boceprevir ADR
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anemia, neutropenia
-NVD and dysgeusia -chills |
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Telaprevir ADR
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-rash, pruritus
-anemia, fatigue -NVD and dysgeusia -anorectal irritation/itching, hemorrhoids |
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Boceprevir CI
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-alfuzosin
-carbbamazepine, phenobarbital, phenytoin -rifampin -dihydroergotamine, ergonovine, ergotamine, methylergonovine -cisapride -st johns wart -lovastatin, simvastatin -drospirenone -pimozide -sildenafil or tadalafil for plum htn -triazolam, oral midazolam |
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Telaprevir CI
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-alfuzosin
-rifampin -dihydroergotamine, ergonovine, ergotamine, methylergonovine -cisapride -st johns wart -atorvastatin, simvastatin, lovastatin -pimozide -sildenafil or tadalafil for pulm htn triazolam, oral midazolam |
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HIV and HCV
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HIV has an adverse impact on liver disease related to HCV
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HIV and HCV treatment
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with cocktail containing 3A4 do not use direct acting antivirals.....48 week treatment
-w/o cocktail containing 3A4, use with direct acting antivirals |
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ADR management
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-neutropenia; give neupogen
-anemia; give erythropoietin or darbepoetin -mitochondrial toxicity; avoid ddI, d4T, AZT |
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Hep B transmission
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sex, blood, perinatal
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it is in blood, wound, semen, vaginal fluid, and saliva
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Hep B clinical presentations
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-ALT/AST increases, then bilirubin 1000-2000 IU/L
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ALT returns to normal in 1-4 months, if >6 months indicates chronic HBV.
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HBsAg
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indicates that the person is infected
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positive=HBV
negative= no HBV, could be immune |
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Anti-HBs
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-indicates immunity from HBV
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positive= immune
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Total Anti-HBc
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-indicates previous or ongoing infection with HBV, immune from infection, not vaccine
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4 hepatitis stages
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1. incubation; first exposure
2. preicteric; before jaundice 3. icteric; jaundice 4. convalescence; gradual recovery |
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Hepatitis A transmission
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oral-fecal route
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3rd world country, MSM, illegal drug users
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Anti-HAV IgM
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presence indicates acute reaction
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Anti-HAV IgG
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does not distinguish between past, current infection or immunity
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Hepatitis A vaccine
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dose at 0 month, 6-12 month
ADR: injection pain, HA, myalgia, malaise |
Havrix and Vaqta
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Treatment for Hepatitis A, E, G
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supportive care
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hydration, avoid alcohol, avoid, tylenol
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HCV transmission baby
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-limited to women who are positive at delivery
-no need to avoid pregnancy or breastfeeding |
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Treatment for HCV genotype 1
w/ boceprevir w/ telaprevir |
1. 4 weeks of PegIF/RBV
2. Initiate Boceprevir 3. Test HCV at week 8 and week 12 4. If detectable at week 8, and undetectable at 12; continue PefIF/RBV for total of 32 weeks. 5. At week 36, DC boceprevir, continue PegIF/RBV for 12 more weeks. 6. If undetectable HCV RNA at both week 8 and week 12, continue PegIFN/RBV/Boceprevir for 24 weeks. |
1. Initiate PegINF/RBV/telaprevir for 12 weeks.
2. HCV RNA at week 4 and 12. 3. If detectable at week 4, stop Telaprevir at week 12, continue regimen for total of 48 weeks. 4. If undetectable, stop telaprevir at week 12, continue PegIF/RBV for 12 weeks. |
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IgM Anti-HBc
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indicates recent infection within less than 6 months. Determines chronic vs acute.
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positive=acute
negative=chronic |
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Test hepatitis B DNA viral load
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if positive > 6 months, chronic infection
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HBV needs treatment if?
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1. acute liver failure
2. cirrhosis and clinical complication 3. cirrhosis or advanced fibrosis and HBV DNA in serum 4. Patients who will be receiving cancer chemotherapy or immunosuppressive therapy |
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goals of hepatitis b therapy
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prolonged viral suppression
-reduction in necroinflammation, fibrosis, and cirrhosis -reduction in decompensation -reduction in rates of HCC -reduction in mortality |
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medications to treat chronic HBV
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1. lamivudine
2. interferon a-2b 3. entecavir 4. telbivudine 5. tenofovir 6. peg interferon a-2a |
non fda approved
-emtricitabine and famciclovir |
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lamivudine
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100mg daily, low dose reduced side effects, 50% respond. 20% will develop resistance
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interferon a-2b
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-neuropsychiatric (depression, suicide)
-hypersensitivity rxn -flu-like symptoms, weight loss, hypotension, bone marrow depression, autoimmune, colitis, pancreatitis |
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adefovir
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-10mg daily
-renal dysfunction at high doses, low at 10 mg - well tolerated -resistance 2% at 1 year and 7% at 2 year -liver |
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entecavir
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.5 mg daily for naive
1 mg for lamivudine failure -ADR: GI; NVD, dyspepsia, insomnia, dizzy, HA, fatigue 0% resistance at 1 year - |
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tenofovir
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600mg daily, same as HIV
-ADR Nausea, abdominal pain, HA, URTI, nasophyngitis, malaise, increase CPK |
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Peg interferon a-2a
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180mcg qweek for 48 weeks.
-any longer need to change regimen -neuropsychiatric (depression, suicide) -hypersensitivity rxn -flu-like symptoms, weight loss, hypotension, bone marrow depression, autoimmune, colitis, pancreatitis |
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Risk factors with progression of HBV
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Cirrhosis
-older age -HBV genotype C -high viral load -habitual EtOH -concurrent infection -smoking, carcinogens |
Hepatocellular Carcinoma
-male -old -FH of HCC -history of reversion -cirrhosis HBV type C -core promoter mutation -Heavy EtOH -smoking |
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vaccines for Hep B
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engerix-B
recombivax-HB Heptavax-B TwinRX is hep A and B |
vaccine at 0,1, and 6 months
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treatment for acute exposure of HBV
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H-Big and Hep B vaccine if not received yet
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Hepatitis D
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needs co infection with Hep B to spreat
Percutaneous exposure Interferon Response to therapy is poor |
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