Hepatitis Flashcards
(44 cards)
Complications of HAV
- Usually improves w/o sequelae w/in 2mos
- relapsing hepatitis - 1 in 7
- during 6mos after acute infection
- prolonged cholestatic hepatitis >12wks
- <5%, resolves spontaneously
hepatitis in pregnancy a/w guillain-barre
HEV
Most effective therapies for tx cHBV
tenofovir (esp HIV)
entecavir
lamivudine - used in HIV, but has high rate of R development (30%)
Important complication of tx of HCV
HBV reactivation w/ flares of hepatitis, occasionally severe enough to require liver transplant or result in death
Who to screen for HCC in chronic HBV infection
- all pts w/ cirrhosis
- Asian M >40yo; Asian F >50yo
- African >20yo
- FH of HCC
Frequent extrahepatic manifestations of HCV
- AI thyroiditis
- B-cell NHL
- lichen planus
- porphyria cutanea tarda
- cryoglobulinemia: vasculitis, glomerulonephritis
Genotypes of HEV
- Genotype 1,2 - Asia, N Africa
- no animal reservoir
- Genotype - endemic in swine - butchers and farmers
Endemic in most of the developing world
Infectious related causes of hepatic parenchymal disease
- ART toxicity: ABC, nevirapine (classically). Can be seen with almost all ART
- Malignancy: KS, HCC
- Biliary disease: AIDS cholangiopathy
Common cause of hepatitis in children
worsened liver failure w/ chronic HBV/HCV
think parvovirus B19
exposure: contaminated water
jaundice, abd pn, + fever/HA/myalgias
consider lepto
Travel to SA or Africa
range from mild febrile illness to fulminant liver failure
consider yellow fever
Persons w/ isolated HBcAb+ in high-risk groups (BMT, SOT, ritux, HDS)
represents occult HBV most commonly
- need vaccination
- (note: if HBsAg+ –> need ppx always)
Tx HBV if…
- GFR 30-60
- GFR 10-30
- GFR <10 (no RRT)
- RRT
- GFR 30-60: TAF
- GFR 10-30: TAF or entecavir
- GFR <10 (no RRT): entecavir
- RRT: TDF or TAF or entecavir (anything)
When to tx pregnant women with HBV
*rec all pregnant women have HBV DNA
Tx if DNA >200k
The 4 preferred tx for chronic HBV
- Entevacir
- TAF
- TDF
- Peg-IFN
When to tx HBV
when high replication plus disease (ie liver damage) - phases 2 and 4 of natural history
- w/ HBeAg positive disease: limits are ALT >2xULN and DNA >20k
- w/ HBeAg negative disease: limits are ALT>2xULN and DNA >2k
HBV Disease Phase:
HBsAg negative
HBeAg-
HBV DNA <10
ALT normal
Liver disease none
resolved HBV infection (HBsAg-/anti-HBc Ab+)
(Phase 5)
HBV Disease Phase:
HBsAg - intermediate
HBeAg -
HBV DNA >2k
ALT elevated
Liver disease mod/sev
HBeAg- chronic HBV
(Phase 4)
*req tx
HBV Disease Phase:
HBsAg low
HBeAg -
HBV DNA <2k
ALT normal
Liver disease none
chronic HBC infection - inactive carrier
(Phase 3)
*latent/nonreplicative phase
HBV Disease Phase:
HBsAg high/intermediate
HBeAg +
HBV DNA 10^4-10^7
ALT elevated
Liver disease mod/sev
chronic HBV - immune reactive (Phase 2)
*req tx
HBV Disease Phase:
HBsAg high
HBeAg +
HBV DNA >10^7
ALT normal
Liver disease none/minimal
Chronic HBV infection - immune tolerant
(Phase 1)
Essential evaluation with chronic HBV
eAg, HBV DNA, HDV, genotype
HIV
stage (LFT, elastrography or bx)
renal status
u/s to r/o HCC (Asian, M>40yo, F>50yo, AA>25-30yo)
Which HCV regimen to avoid in pts with HIV on PI
grazoprevir (an HCV PI)
PIs interact (similarly, boosters will effect levels)
Which HCV regimens have concern with tenofovir?
sofosbuvir (TDF can increase sofosbuvir)
