1
Q
What types of hepatitis are most likely to be asymptomatic?
A
- HBV
- HBC
2
Q
What types of hepatitis is symptomatic?
A
HAV
3
Q
What viral specific test is used for HAV?
A
IgM anti-HAV
4
Q
What viral specific test is used for HBV?
A
- IgM anti-HBC (+)
- HBsAG (+)
5
Q
True or False: HAV is preventable
A
True
6
Q
True or False: HAV is treatable
A
False
7
Q
True or False: HAV is not curable
A
False
8
Q
How is HAV transmitted?
A
- Person to person
- Ingestion of contaminated food/water
9
Q
What patient population can be asymptomatic carriers to HAV?
A
Children
10
Q
How long does HAV last?
A
2 months
11
Q
What type of hepatitis is considered acute?
A
HAV
12
Q
True or False: HAV has a high mortality rate
A
False
13
Q
What patients are more susceptible to mortality with HAV?
A
- Older patients
- Ones with a waning immune system
14
Q
What 6 clinical presentations are shown with HAV?
A
- Flu-like symptoms
- GI upset
- Dark urine
- Alcoholic stools
- Pruritis
- Jaundice and sclera icterus
15
Q
True or False: There is no role for antiviral agents in HAV
A
True
16
Q
What are the 2 key things for prevention in HAV?
A
- Vaccine
- Immunoglobulin
17
Q
HAV vaccines are recommended for what age?
A
All children at 1 year of age
18
Q
If previously unvaccinated for HAV, when should patients get the vaccine?
A
Prior to travel
19
Q
What patients can utilize HAV immunoglobulin?
A
- Not previously vaccinated
- Immunocompromised patients
- Patients with chronic liver disease
20
Q
When can short term pre-exposure prophylaxis with HAV immunoglobulin be used?
A
If traveling soon < 2 weeks
21
Q
How long does pre and post exposure prophylaxis last with the 0.02 dose of immunoglobulin?
A
3 months
22
Q
How long does pre and post exposure prophylaxis last with the 0.06 dose of immunoglobulin?
A
5 months
23
Q
True or False: the immunoglobulin should only be used by itself and cannot be combined with the HAV vaccine
A
False
24
Q
True or False: HBV is preventable
A
True
25
True or False: HBV is not curable
True
26
True or False: HBV is not treatable
False
27
How is HBV transmitted?
1. Sexually
2. Parenterally
3. Perinatally
28
What can HBV cause?
Chronic hepatitis
29
What does HBV have a risk for? 2
1. Cirrhosis
2. Hepatocellular carcinoma
30
What are 7 risk factors for HBV?
1. Multiple high risk sexual partners
2. Men who have sex with men
3. Injection-drug use
4. Household contact
5. Healthcare workers at risk for blood exposure
6. Hemodialysis patients
7. Travel to HBV endemic countries
31
What is the incubation period for HBV?
4-10 weeks
32
True or False: HBV can be self limiting or a seroconverting disease
True
33
-HBsAG: negative
- anti-HBc: negative
-anti-HBs: negative
Susceptible
34
-HBsAG: negative
- anti-HBc: positive
-anti-HBs: positive
Immune due to natural infection
35
-HBsAG: negative
- anti-HBc: negative
-anti-HBs: positive
Immune due to HBV vaccination
36
-HBsAG: negative
- anti-HBc: negative
-anti-HBs: negative
-IgM anti-HBC: positive
Acutely infected
37
-HBsAG: positive
- anti-HBc: positive
-anti-HBs: negative
-IgM anti-HBC: negative
Chronically infected
38
What is a marker for treatment success in HBV but is not present in all patients?
HBeAg
39
What are the 2 main drugs used to treat HBV?
1. Tenofovir
2. Entecavir
40
When should entecavir be taken?
On an empty stomach
41
What does tenofovir have lower rates of?
1. Renal
AND
2. Bone adverse effects
42
Lamivudine has a _____ dose in HBV than in HIV
Lower
43
What drug used in HBV can increase the immune response and inflammation?
Interferon-alpha
44
What is the main ADE seen with interferon-alpha?
Neuropsychiatric disorders (depression)
45
What HBV viral load is needed for treatment?
>20,000
46
What does the ALT threshold need to be for treatment in HBV?
>2x upper normal limit
47
How would you treat patients who are HBeAg positive?
1. Treatment until HBeAg seroconversion to anti-HBeAg
2. Undetectable HBV viral load
3. Additional 6 months of treatment
48
How would you treat HBeAg negative patients?
Until HBsAg clearance
49
What does **HBsAg** show?
Surface antigens
50
What does **positive** anti-HBc show?
No active immunity
51
What does **negative** anti-HBc show?
Active immunity
52
What does **anti-HBs** show?
Surface antibodies
53
How many doses of HBV are needed at child birth?
3-dose series
54
When should you administer HBV immunoglobulin for needle stick exposure?
< or = to 7 days
55
When should you administer HBV immunoglobulin for sexual exposures?
< or = 14 days
56
How long does HBV immunoglobulin provide passive antibody protection?
3-6 months
57
True or False: HCV is not preventable
True
58
True or False: HCV is treatable
True
59
True or False: HCV is not curable
False
60
What is the most common blood borne pathogen?
HCV
61
What can chronic HCV result in?
End stage liver disease
62
How is HCV transmitted?
1. Parenterally
2. Sexually
3. Perinatally
63
Blood transfusions or transplants before _________ is a risk factor for HCV
July 1992
64
Clotting factors given before _____ is a risk factor for HCV
1987
65
True or False: IVDU is a risk factor for HCV
True
66
True or False: professionally done tattoos are a risk factor for HCV
False
67
True or False: most patients are symptomatic in acute and chronic HCV
False (asymptomatic)
68
What are the 2 laboratory criteria for diagnosing HCV?
1. HCV RNA
2. Anti-HCV antibodies
69
What process in the HCV lifecycle do the drugs target?
Poly protein processing
70
What is a black box warning for DAAs?
HBV reactivation
71
What are two drug interactions for the DAAs?
1. All contraindicated with strong CYP3A4 inhibitors
2. Can increase the risk of myopathy with statin use
72
What should you monitor for with simeprevir?
LFTs
73
Simeprevir
OLYSIO
74
What should you avoid using Sofosbuvir with? Why?
Amiodarone —> serious bradycardia
75
What test should be used prior to using Olysio?
Resistance test
76
Sofosbuvir/Ledipasvir
Harvoni
77
What Sofosbuvir combination is approved in children?
Sofosbuvir/Ledipasvir (harvoni)
78
Sofosbuvir/ Velpatasvir
Epclusa
79
What Sofosbuvir combination has pan-genotyping therapy?
Sofosbuvir/ Veloatasvir (Epclusa)
80
Sofosbuvir/ Velpatasvir/Voxilaprevir
Vosevi
81
What Sofosbuvir combination is used for salvage therapy?
Sofosbuvir/ Velpatasvir/Voxilaprevir (Volsevi)
82
For all Sofosbuvir combinations, what should they be separated from?
1. Antacids
2. H2RAs
3. PPIs
83
What DAA combination has higher rates of hepatic failure?
Viekira
84
Ombitasvir/Paritaprevir/Ritonavir/Dasabuvir
Viekira
85
What should you test for with Daclatasvir?
NS5A resistance
86
What should you test for with Zepatier?
NS5A resistance
87
What does Zepatier have a higher risk of?
LFT elevation
88
How long is the Mavyret regimen?
8 weeks
89
Elbasvir/Grazoprevir
Zepatier
90
Glecaprevir/Pibrentasvir
Mavyret
91
What are 2 things Mavyret are used for?
1. Pan-genotypic
2. Salvage therapy
92
Mavyret has a lower drug interaction potential because it inhibits what?
P-glycoprotein
93
How long is the duration for Harvoni?
12 weeks
94
For Harvoni, what is needed for use?
1. HIV uninfected
2. HCV RNA < 6 million
95
How long is the duration of Harvoni for HIV infected patients or with a viral load of >6 million?
12 weeks
96
How long is the duration for Epclusa?
12 weeks
97
What is used as an alternative for genotype 1a with cirrhosis?
Zepatier
98
How long is Epclusa used for genotype 2 patients without cirrhosis?
12 weeks
99
What should patients avoid after receiving DAA?
Excessive alcohol use
