Hepatitis

Question 1

For hepatitis A, B, and C, what are their below characteristics:
- acute vs. chronic
- transmission
- vaccine?
- first-line treatment
- other treatments for select patients (Hep C)

Answer 1

Hep A:
- acute only
- transmission: fecal-oral
- vaccine: yes
- first-line treatment: supportive

Hep B:
- acute and chronic
- transmission: bodily fluids, blood
- vaccine: yes
- first-line treatment: PEG-IFN or NRTI (tenofovir or entecavir)

Hep C:
- acute and chronic
- transmission: blood
- vaccine: no
- first-line treatment: if treatment naive, direct-acting antivirals (DAA) combination
- for select patients: DAA combination + RBV

Question 2

What are the 2 recommended treatments for all genotypes of Hep C (treatment naive)? What are their brand names?

Answer 2

glecaprevir/pibrentasvir (Mavyret) for 8 weeks
sofosbuvir/velpatasvir (Epclusa) for 12 weeks

Question 3

What are the name clues for these hepatitis C drugs:
- NS3/4A protease inhibitors
- NS5A replication complex inhibitors
- NS5B polymerase inhibitors

Answer 3

NS3/4A protease inhibitors: - previr
- ex. glecaprevir, grazoprevir, voxilaprevir
- (take these with food)

NS5A replication complex inhibitors: - asvir
- ex. elbasvir, ledipasvir, pibrentasvir, velpatasvir

NS5V polymerase inhibitors: - buvir
- ex. sofosbuvir

Question 4

What is a boxed warning of all direct-acting antivirals? What is a significant drug interaction with all DAAs?

Answer 4

Boxed warning: Risk of reactivating HBV. Test all patients for HBV before starting DAA.

Drug interaction: avoid strong inducers of CYP3A4

Question 5

What hepatitis medication should we NOT use with amiodarone and why?

Answer 5

do not use sofosbuvir products with amiodarone due to the risk of bradycardia

Sofosbuvir products: Epclusa, Harvoni, Vosevi

Question 6

What is important to know when treating females with ribavirin?

Answer 6

Ribavirin is teratogenic, so females should avoid pregnancy during treatment and for 6-9 months after completion. At least 2 reliable forms of effective contraception are required.

Question 7

What are 3 boxed warnings with all HBV NRTIs?

Answer 7

• lactic acidosis (can be fatal)
• severe hepatomegaly with steatosis (can be fatal)
• exacerbations of HBV can occur upon discontinuation

Question 8

What are the brand names for these HBV treatments: tenofovir disoproxil fumarate, tenofovir alafenamide? What are 3 warnings with these medications?

Answer 8

tenofovir disoproxil fumarate (Viread)
tenofovir alafenamide (Vemlidy)

Warnings
- renal toxicity
- Fanconi syndrome
- decreased bone mineral density

Question 9

What is the brand name of entecavir for HBV? Should it be taken with or without food?

Answer 9

entecavir (Baraclude)

Take on an empty stomach

Question 10

Can you use HBV lamivudine for HIV?

Answer 10

No, the HBV formulation has a lower concentration of lamivudine so it could result in HIV resistance

Question 11

How often if PEG-IFN-alfa dosed? What are 4 side effects?

Answer 11

Dosed SC weekly

Side effects
- CNS effects (fatigue, depression)
- GI upset
- increase LFTs (5-10x ULN)
- flu-like syndrome (pre-treat w/ acetaminophen and antihistamine)