Part 2 Revision > HBV > Flashcards

HBV Flashcards

(116 cards)

Study These Flashcards
1
Q

What type of virus is HBV?

A

Family: Hepadnaviridae
Genus: Orthohepadnavirus
Small (42nm), Enveloped, Partially dsDNA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is 5Y cumulative incidence of cirrhosis in an untreated CHB pt?

A

8-20%.

Among those with cirrhosis; the 5Y risk of decompensation is 20%.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the annual risk of HCC in pts with cirrhosis?

A

2-5%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the host related risk factors for developing HCC in untreated CHB pt?

A

Chronic hepatitis necroinflamfmation/Cirrhosis

Co-infection with other hepatitis viruses or HIV

Male/older age/ African origin/FH of HCC

Alcohol abuse/Active smoking

DM/Metabolic syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are HBV properties that increase risk of HCC in untreated CHB pt?

A

High HBV DNA &/or
HBV genotype C > B*
Specific mutations

  • C for cancer
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the components of the initial assessment of pts with chronic HBV infection?

A

1)Complete history + physical examination

2)Assessment of liver disease activity and severity > identify pts for ttt and HCC surveillance.
-physical exam
-biochemical tests (AST/ALT/GGT/ALP/bilirubin/Albumin/gamma globulin/FBC/PT)
-liver USS
* if above inconclusive: liver biopsy or non-invasive (Elastography)

3)Assessment of markers of HBV infection.
-HBaAg and Anti-HBe
-HBV DNA serum level
-HBsAg quantification

4) Exclude other causes of CLD (AI/Metabolic/alcohol..)

5) Exclude co-infection with HDV/HCV/HIV.

6) Check anti-HAV IgG ( if negative > vaccinate)

** ALL 1st degree relatives/sexual partners should be tested (HBsAg/HBsAb/HBcAb) +/- vaccination

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Define the following in relation to HBV ttt:
1)Main endpoint?

2)Valuable endpoint?

3)Additional endpoint?

4)Optimal endpoint?

A

1)The induction of LT suppression of HBV DNA levels.

2)The induction of HBeAg loss +/- Anti-HBe sero-conversion (in HBeAg pos CHB pts)

3)Biochemical response; normalisation of ALT

4) HBsAg loss +/- Anti-HBs sero-conversion (Functional cure).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the indications for ttt?

A

Should be treated:

1) All pts with chronic Hepatitis HBV DNA > 2000 IU/ml and
ALT > ULN and/OR
At least moderate necroinflmmation/fibrosis

2)Cirrhosis (comp/decomp) with any detectable HBV DNA *Regardless of ALT

3)HBV DNA > 20,000 and
ALT > 2ULN
*Regardless of fibrosis degree

May be treated ( Have infection NOT hepatitis):

4)HBeAg-pos + persistent normal ALT + high HBV DNA + > 30Y
*Regardless of fibrosis degree

5)FH of HCC/Cirrhosis and Extra-hepatic manifestation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What A) monitoring and B) how frequent is required for pts NOT on ttt?

A

A) HBV DNA, ALT, fibrosis (noninvasive).

B)
HBeAg-pos + <30Y = 3-6M

HBeAg-neg + HBV DNA < 2000iu/ml = 6-12M

HbeAg-neg + HBV DNA =/>2000iu/ml = 3M for the 1st Y, then 6M

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is A) the rationale for pegIFNa ttt and B) what is the main disadvantage?

A

A) Is to induce LT immunological control with finite duration ttt.

B) High variability of response and side effects.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the types of ttt response?

A

Virological

Serological

Biochemical

Histological

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Define Virological response to NA ttt?

A

1)During ttt:

Virological response: HBV DNA ND using PCR with LOD of 10iu/ml

1ry non-response: <1log10 decrease in HBV DNA after 3M of ttt

Partial response: decrease in HBV DNA >1log 10 BUT still detected after 12M of ttt.

Virological breakthrough: increase in HBV DNA >1log10 compared to nadir level on ttt

2)After stopping ttt:

SVR: HBV DNA <2000iu/ml at least 12M post-stopping.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Define virological response to pegIFNa ttt?

A

On ttt: HBV DNA <2000iu/ml at 6M and at end of ttt

After stopping: HBV DNA <2000iu/ml for at least 12M

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Define Histological response to ttt?

A

Decrease in necroinflammation activity* without worsening in fibrosis compared to pre-ttt findings.

*by =/> 2 points in histologic activity index or Ishaks system🤷🏻‍♀️

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Define sustained biochemical response?

A

Normal ALT on a minimum follow up 3 monthly for a year post ttt.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Define serological response to ttt?

A

1) for HBeAg-pos pts: loss + Anti-HBe.

2) for all pts: loss of HBsAg + Anti-HBs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What sort of virus is HBV? What size is it

A

Hepadnavirus, small enveloped partly ds relaxed circular DNA

42 nm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Where does HBV replicate?

A

Exclusively in hepatocytes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

How many genotypes of HBV are there? What gene is sequenced for genotyping

A

10 (A-J) sequencing S gene

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What does the HBsAg assay detect in relation to virus?

A

Infected cells usually secrete 100-1000 times as many empty polymers of envelope protein as they do infectious virus - this is what is detected in HBsAg assays

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is cccDNA?

A

Covalently closed circular DNA
Conversion of rcDNA into cccDNA requires completion of the +DNA strand

cccDNA remains in the nucleus as an episomal minichromosome

cccDNA is transcribed into 4 viral RNAS
Pre-Core mRNA, pregenomic RNA, L mRNA
M mRNA and S mRNA
X mRNA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is the pre-core protein cleaved into?

What is the relevance of this?

A

HBeAg, therefore HBeAg is directly related to the level of cccDNA transcription and hence viral load

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Where is each HBV genotype most commonly from geographically?

A

B & C = Asia (and vertical transmission)
A, D & E = Africa
G, H & F = America
A = UK

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Incubation period of HBV

A

Approx 12 weeks (range 40-160 d)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
What % of acute HBV is symptomatic?
One third
26
In what situation should patients with acute HBV be treated?
Only in severe disease i.e. coagulopathy INR >1.5 or protracted course
27
Symptoms of acute HBV
Anorexia Nausea Upper right quadrant pain Severe fatigue Jaundice (not always present) Remember to inform PH!
28
Definition of chronic HBV? Rate of chronicity in: a) Perinatally infected children b) Children infected at 1-5 years c) Healthy adults
a) 90% b) 20-50% c) 5%
29
HBeAg, HBV DNA, ALT in: a) HBeAg+ chronic infection b) HBeAg+ chronic hepatitis c) HBeAg- chronic infection d) HBeAg- chronic hepatitis e) HBsAg- phase
a) HBeAg, very high DNA, normal ALT b) HBeAg, very high DNA, raised ALT c) Anti-HBe, <2000 IU/ml, normal ALT d) Anti-Hbe, moderate-high DNA, raised ALT and fibrosis e) HBsAg negative, undetectable DNA (not always), cccDNA in the liver
30
What proportion of patients with chronic HBV will develop progressive liver disease?
25% Cirrhosis > 20% annual risk of decompensated liver disease >5 year survival rates can be as low as 15% Cirrhosis > 5% risk of HBV related hepatocellular carcinoma
31
Extrahepatic manifestations of HBV
Serum-sickness like immunological syndrome Cervical NHL Cryoglobulinaemia Polyarteritis
32
Define occult hep B
Presence of replication competent cccDNA in the liver and/or HBV DNA in blood in patients with no detectable HBsAg DNA negative or very low (<200 IU/ml) and intermitently detected Gold standard is detection of relication competent HBV DNA in liver 'S-escape mutants' in which HBsAg is not detected by current assays - may look like occult HBV
33
Why is occult HBV an issue for the blood supply and how can it be protected?
Infectious dose of HBV is below the limit of detection of NAATs Methods of screening donors to reduce HBV transmission would be: Excluding anti-HBc positive donors Reducing LOD to 0.15 IU/ml Testing samples individually by NAAT rather than in minipools
34
What are the risk factors for HBV related HCC? What is a marker used to monitor risk?
Host factors: cirrhosis, comorbidity, age Viral factors: DNA and HBsAg level, genotype (C higher risk?) Alpha-fetoprotein
35
Initial work up for new diagnosis of HBV
LFTs FBC Prothrombin time Hepatic ultrasound Fibroscan (transient elastography) HBeAg/HBeAb, DNA, HBsAg, HDV HAV IgG (if neg offer vaccine) FIB-4 (Age, ALT, AST, platelets)
36
What is HBsAb directed against?
A range of epitopes on the 'a' determinant of the surface protein - it is considered a neutralizing antibody
37
What is the minimum level of HBsAb considered protective?
10 IU/ml confers protection but 100 IU/ml is preferable as per DHSC
38
What antigen can cross the placenta and act as a 'tolerogen'?
HBeAg
39
Possible causes of isolated anti-HBc?
False positive Occult HBV Early resolving infection when HBsAb about to come up Resolved HBV with waning HBsAb (HBeAb can sometimes be positive)
40
What quant HBV assays are available? What POC HBV assays are available
Alinity m and Realtime HBV (Abbott) Artus HBV (Qiagen) AccuPower HBV (Bioneer) Cobas HBV (Roche) Aptima HBV (Hologic) Cepheid GeneXpert Truenat HBV (Molbio)
41
What is HBV core related antigen (HBcrAg)
New biomarker containing several antigens HBcAg, HBeAg, prec22 protein Can be detected in Dane particles and DNA neg particles which contain the pre core protein and are 100x more prevalent than Dane particles May provide info on the translational activity of HBV May reflect amount of cccDNA in hepatocytes and predict risk of HCC
42
When would you use sequencing in HBV infection?
Can be used to determine vaccine escape mutants (esp in mother to child transmission post vaccine) Can identify pre-core mutants (e-null mutants) caused by premature stop codon in precore region (less common in GTA) Phylogenetic analysis can be used in outbreaks Detecting HBcAg mutants with mutations in basal core promotor region
43
What is the goal of HBV treatment? What is the main endpoint? What is the optimal endpoint?
Reduce progression to liver damage and therefore HCC Main endpoint is long term suppression of replication Optimal endpoint is HBsAg loss
44
Which patients are eligible for HBV treatment as per EASL?
1) Patients with cirrhosis (and ALT, any DNA) 2) DNA >2000 IU/ml, raised ALT and/or at least moderate fibrosis 3) Patients with HBV DNA >20,000 and ALT >2xULN 4) >30 y and HBeAg+ CHB with normal ALT and high DNA 5) Family history of HCC or cirrhosis/extrahepatic manisfestations
45
What are first line treatments for chronic HBV?
Entecavir or tenofovir Peg-IFN can be considered for mild to moderate CHB
46
What are four endpoints of HBV treatment?
Long term suppression of HBV DNA (biomarker most associated with disease progression) HBeAg loss (represents some immune control) ALT normalisation Optimal endpoint - HBsAg loss (functional cure)
47
Name 3 NAs used for HBV with low barrier to resistance and 2 with high barrier to resistance
Low barrier to resistance Lamivudine Adefovir Telbivudine High barrier to resistance Tenofovir (TDF and TAF) Entecavir
48
What are the two NAs recommended for HBV treatment in EASL?
Tenofovir or entecavir monotherapy
49
What two issues do you need to be aware of in NA treatment of HBV?
Dose reduction for renal disease (and monitor) Bone and renal issues with TDF
50
What are the stopping rules for NA treatment of HBV?
1) Stop after HBsAg loss 2) In non-cirrhotic HBeAg+ can stop if HBeAb and undetectable DNA and 12 months of consolidation therapy 3) In non-cirrhotic HBeAg - patients, can stop if undetectable DNA for >3 y (but close monitoring)
51
HBV/HIV co-infection - what should their cART regimen contain?
Tenofovir
52
What needs to continue after cessation of HBV treatment?
Monitoring for HCC
53
Pros and cons of Peg IFNa for HBV
Pros: Finite treatment duration (48 w) Long term immune control No risk of resistance Low risk of relapse Cons: Subcut injection(weekly) Many contraindications Poorly tolerated
54
When can Peg-IFN? not be used for HBV treatment?
Patients with decompensated cirrhosis Pregnancy
55
What is the duration of Peg-IFNa for HBV?
48 weeks Early stopping rules in place for non-responders
56
Which patients have most success with Peg-IFNa treatment in HBV?
HBeAg+ patients 20-30% HBsAg loss
57
What is one of the main side effects of Peg-IFN? treatment?
Thyroid dysfunction
58
What is first line HBV treatment as per NICE? What is second line?
Peg-IFN? TDF (entecavir is an alternative)
59
What does NICE receommend if HBV DNA detectable at 96 weeks of NA treatment?
1) check adherence 2) add lamivudine if no history of lamivudine resistance (HB 3) add entecavir if history of lamivudine resistance (HBsAg+)
60
Main updates in WHO 2024 HBV guidelines
Treat all with significant fibrosis (>7kPa) previously only cirrhosis Treat all with DNA >2000, previously >20,000 IU/ml and ALT above ULN Treat all patients with coinfections, comorbidities, immunosuppression or extra hepatic manifestations
61
What is the risk of HBV transmission in pregnancy without prophylaxis?
70-90% for HBeAg+ 40% for HBeAg-
62
When should testing for e markers and DNA be performed by during pregnancy?
By 24 weeks gestation
63
What are risk factors for HBV transmission in pregnancy?
IgM positive eAg positive Anti-HBe negative DNA >200,000 IU/ml HBsAg >4 log
64
Which women should be treated for HBV during pregnancy?
All patients eligible for treatment due to liver disease etc Women who aren't eligible for treatment, should still be treated in last trimester if >200,000 IU/ml to to reduce VL at delivery as 10% transmission risk of HBV if VL >200,000 despite HBIG and vaccination
65
When should women be treated for HBV in pregnancy? And what is the treatment?
TDF from week 24-28 weeks
66
If women are being treated for HBV what should this treatment be changed to when pregnant?
Tenofovir
67
If women are treated for HBV to reduce perinatal transmission, when should their treatment be stopped? What should be monitored?
Treatment should be stopped by 12 weeks post partum, and they should be monitored for HBV flares
68
Should women with HBV have a C-section? Can they breastfeed?
No (although can be considered for Asian women with >6.14 log viral load!) Women should breastfeed (unless cracked nipples or infant has oral ulcers)
69
What test is collected on babies born to HBV positive mothers and when?
DBS at birth (pre-PEP) for neonates born to high risk mothers HBsAg tested at 12 months
70
Risk of HBV infection in pregnancy?
Risk of transmission to foetus High VL but low ALT during pregnancy Flares in pregnancy are common, close follow up for 6 m post partum More likely to eAg seroconvert
71
Definition of reactivation in: a) HBsAg+ DNA+ b) HBsAg+ DNA- c) HBsAg- DNA- d) HBsAg- DNA+
a) >2log increase in VL b) DNA > 100 on 2 occasions c) detectable HBsAg or DNA d) ?occult HBV (as per a)
72
Which treatments are considered a) high risk b) moderate risk or c) low risk for HBV reactivation?
a) >10% risk eg rituximab, JAK inhibitors, HSCT b) 1-10% risk CAR-T c) <1% eg methotrexate, azathioprine
73
Actions for patients with a) HBsAg+ CHB b) anti-HBc +, HBsAg- treated with agents causing HBV reactivation with: a) high risk b) moderate risk c) low risk
a) NA prophylaxis for both b) NA prophylaxis for a) and either NA prophylaxis or monitoring for b) c) monitoring
74
What prophylaxis is given when patients are at risk of HBV reactivation? If not on prophylaxis, what monitoring is performed?
Lamivudine or entecavir or tenofovir HBsAg/DNA/ALT every 1-3 months with pre-emptive therapy with ETV/TDF/TAF
75
In immunosuppressed patients being treated/prophylaxed for HBV reactivation, when should NAs be stopped post immunosuppression?
12 months (18 months for rituximab 12-24 m for HSCT) monitoring for late reactivation is essential
76
Management of HSCT recipient whose donor is anti-HBc positive?
Lamivudine prophylaxis for 12-24 m
77
How are HBV positive patients managed when on dialysis?
Separate machines required
78
How are HBV negative patients managed when on dialysis?
Vaccination - <100 IU/ml is considered non responder HBsAg testing every 3 m (or 6 m if known to be HBsAb >100)
79
HBV vaccine schedules: Childhood Standard Accelerated
a) 8,12, 16 weeks b) 0, 1, 6 months c) 0, 1, 2, 12 months
80
HBV vaccines, what is special about: Fendrix PreHevbri HEPLISAV B
Fendrix - for renal insufficiency PreHevbri - tri-antigenic monovalent vaccine in cell culture. Good for poor responders HEPLISAV B - two dose schedule
81
Which patients get antibody testing post HBV vaccine? When does testing occur and what if non-response?
Only HCW, organ recipients or dialysis patients Tested 1-2 m post final dose If 10-100 IU/ml give one more booster dose (no Ab testing) If <10 test for current and past infection and rpt course
82
How often are renal dialysis patients tested for anti-HBs? In which situations would they get a booster dose?
Annually or prior to dialysing in high risk country Boosted if <100 mIU/ml
83
When should HBV vaccine and HBIG be administered to neonates born to HBV infected mothers?
First dose of vaccine within 24 h and HBIG within 24 h of vaccine - given at different sites
84
Which neonates get HBV vaccine at birth? Which vaccine?
All neonates born to HBsAg+ mothers and those who will be going home to someone with HBV Engerix or HBVaxPro
85
What situations would require HBIG at birth?
1) acute HBV in pregnancy 2) HBeAb neg 3) HBeAg pos 4) VL of >1x10^6 at any point in pregnancy 5) <1500 g at birth
86
What is the HBV vaccine schedule for neonates born to HBV infected mothers?
1) birth (monovalent) 2) 4 weeks (monovalent) 3) 8 weeks (hexavalent) 4) 12 weeks (hexavalent) 5) 16 weeks (hexavalent) 6) 12 months (monovalent)
87
When can HBIG be administered in relation to vaccine?
Ideally within 24 h but can give up to a week post exposure
88
What might occur if HBIG given after infection has occurred?
May reduce the chance of chronic infection
89
If you test anti-HBs titres in a patient one month after vaccine AND HBIG, what indicates an adequate vaccine response?
>50 mIU/ml likely reflects vaccine response and not circulating HBIG
90
Dose of HBIG for a) newborns b) adults
a) 200-250 iu b) 500 IU
91
HBV PEP post sexual exposure. What 4 actions?
1) baseline testing prior to PEPSE 2) accelerated vaccine course 3) HBIG if within 1 week of last exposure 4) condom use until 3rd dose
92
Can donors with chronic HBV donate tissues?
No, donation is contraindicated
93
HBV testing in organ recipients? What additional tests if anti-HBc positive?
HBsAg, anti-HBc, anti-HBs HBV DNA and HDV serology (also confirmation of core?)
94
Three indications for liver transplant due to HBV? What is required prior to transplant and what is the aim?
1) Severe acute HBV (ALF/fulminant hepatitis /INR >6.5) 2) Decompensated liver disease 3) HCC All patients should be treated with NAs before transplant with the aim of having an undetectable VL prior to transplant
95
Which patients can receive anti-HBc positive liver? What prophylaxis?
HBV immune or non-immune recipients - lifelong lamivudine HBsAg+ recipient - NA and HBIG
96
Which patients can receive HBsAg positive liver? What prophylaxis?
Ideally a HBsAg+ recipient If urgent then HBsAg neg recipient and treat with ETV/TDF
97
Which patients can receive HBV/HDV coinfected liver? What prophylaxis?
No-one - contraindicated in all circumstances
98
What livers can HBV/HDV co-infected patients receive? What prophylaxis?
HBsAg negative livers only to avoid superinfection of transplanted liver Lifelong NA and HBIG (can consider stopping HBIG at >24 m, the aim of HBIG is to keep anti-HBs >100 mIU/ml
99
Can anti-HBc positive, non-liver, organs be donated? What prophylaxis?
Yes, de novo infection is rare 6 months of lamivudine, or consider none if anti-HBs positive
100
Can HBsAg positive, non-liver, organs be donated? What prophylaxis?
HBsAg positive orgnas not usually used unless recipient HBsAg+ Can be used in urgent cases if recipient anti-HBs, and given lamivudine and HBIG post transplant
101
What makes HBV infected patients considered high risk if receiving a liver transplant due to HBV? What prophylaxis is given to high risk patients? What prophylaxis is given to low risk patients?
HCC DNA positive pre-transplant HBeAg+ HIV HBIG and NAs NAs only can be considered, or early withdrawal of HBIG
102
Management of anti-HBc positive recipients of a non-liver organ?
NA prophylaxis or monitoring for reactivation
103
Risk of de novo HBV infection in: anti-HBc positive liver > naive recipient anti-HBc positive liver > anti-HBc positive anti-HBc positive liver > anti-HBc and anti-HBs positive
>50% 10-20% <10%
104
Treatment options for patient with de novo HBV, despite lamivudine prophylaxis, post organ transplant?
Tenofovir - do not use entecavir!
105
Treatment of HBV in patient who has been exposed to lamivudine?
Previous lamivudine exposure can pre-dispose to entecavir resistance, therefore in LAM experienced patients tenofovir should be used for treatment
106
Treatment of HBV in patient who has adefovir resistance?
Entecavir
107
The efficacy of which NA do YMDD mutations impact?
Lamivudine
108
Which two HBV mutations cause intermediate resistance to tenofovir?
A181T/V N236T
109
Which two mutations cause resistance to lamivudine and intermediate resistance to entecavir and adefovir?
M204V/I M204V + L180M
110
What monitoring should be done post organ transplant for: a) HBsAg positive liver transplant recipient b) Recipient with anti-HBc pos organ
Both get DNA and HBsAg monitoring 3 monthly for first year then 6 monthly after, regardless of prophylaxis (not sure if this is for core+ livers or all?)
111
What % of IgM positives are due to HBV flare rather than acute infection? How can you differentiate?
20% anti-HBc avidity testing
112
PH actions for case of acute HBV
Identify close contacts = household and sexual contacts Sexual contacts (last 6 months) Vaccine and HBIG if last sexual contact within 7 days Condom use until third dose of vaccine Test for HBV Household contacts Vaccine Test for HBV
113
Actions for NSI from ?HBV pos source
Remember first aid first! Wash with soap and water PEP within 24 h ideally, or at least within 7 d HBsAg testing at 6, 12, 24 weeks (and storage bloods at d0) No donating blood, and barrier contraception, until HBV ruled out
114
HBV PEP for HBsAg positive source in: Unvaccinated Partially vaccinated Fully vaccinated with primary course Non-responder
Accelerated course plus HBIG One dose of vaccine and finish course Booster dose if >1 y since last dose Booster dose plus HBIG at d0 and d30
115
HBV PEP for unknown source in: Unvaccinated Partially vaccinated Fully vaccinated with primary course Non-responder
Accelerated course One dose of vaccine and finish course Consider booster dose if >1 y since last dose Booster dose plus HBIG at d0 and d30
116
What are pre-core mutants, basal core mutants and Sgene mutations in HBV? What do they mean clinically?
Basal core mutations include double mutant A1762T and G1764A, which reduce HBeAg expression through transcriptional mechanisms. PC mutants have premature stop coding resulting in absent HBeAg expression. These cause increased replication and faster disease progression. S gene mutations include S-escape variants can be undetected by lab tests and immune escape. Causes my mutations in preS/S genomic region
Part 2 Revision
flashcards
Decks in class (57)
# Cards
Brainscape helps you reach your goals faster, through stronger study habits.
© 2026 Bold Learning Solutions. Terms and Conditions