What is the goal for treatment of HBV?
Slow the development of liver disease
Can prevent from progressing to hepatocellular carcinoma
Chronic active hepatitis
Acute hepatitis state that continues without normal recovery (longer than 6-12 months)
What do interferons do within the body?
Interferons are host cytokines that exert complex
antiviral, immunomodulatory and antiproliferative actions
What are the (technically 3) types of interferons used to treat hepatitis?
PEGylated interferon alpha-2b
PEGylated interferon alpha-2a
*The PEGylated interferons are basically the same for our purposes
When would you give an interferon drug?
Treatment of patients with well compensated liver disease
You should NOT give interferons if your patient....
Is planning to be pregnant within 2-3 years
***DANGEROUS to give to patients in decompensated cirrhosis
What are the differnces in duration of action of inferferon alpha 2-b VERSUS PEGylated interferons alpha2a/2b?
Inferferon alpha 2b doesn't last as long as PEGylated interferons
What are the 3 primary functions of interferons in surrmounting an immune response?
1. Protect nearby healthy cells
2. Signal macrophages and NK cells to clear infection
3. Lysosome lysis, lysis of infected cell
What is the MOA of interferon alpha?
Interferon alpha binds to JAK1 and TYK2 which activates them
This causes STAT1 and STAT2 to become active (phosphorylated) and induce the activation of transciption of interferon stimulated genes (ISGs)
What are the adverse effects that occur with interferon alpha/PEGylated interferons?
80-90% of patients experience SOME kind of adverse effect
FLU LIKE SYNDROME
Fatigue and mental depression
What are the dose limiting toxicities associated with interferon alpha/PEGylated interferon?
Bone marrow suppression
What is the MOA of nucleosides/nucleotides treatment for HBV?
HBV DNA reverse transciptase/DNA polymerase inhibitors
How do you take nucleosides/nucleotides for treatment of HBV?
*much easier to take than the interferon drugs
What drugs would you use for a patient that has decompensated cirrhosis?
What are the (3) nucleoSIDE drugs?
What is are the two nucleoTIDE drugs?
Which one has the monophosphate attached?
NucleoTIDES!!! have the monophosphate group
What is the first line treatment for wild-type HBV?
What is the unique AE of tenofovir?
What category drug is tenofovir in?
Nucleotide analog of adenosine
What is the first line treatment of HBV in patients that have renal insufficiency?
What are the TAKE HOME MESSAGES for HBV treatment?
-Therapies for HBV fail to fully eradicate the virus
-RELAPSE of hepatitis induced by HBV is always possible
What are the interferon drugs?
PEGylated interferon alpha 2b
PEGylated interferon alpha 2a
What category is lamivudine in?
What category is telbivudine in?
What category is entecavir in?
What category is tenofovir in?
What cateogory is adefovir in?
Which can be cured?
HBV or HCV?
*remember: HCV has a C in it, so it can be CURED
What is the primary drug used for HCV (historically)?