S45(1) HBV

Question 1

HBV Vaccine for All ages and 3 doses at 0, 1, 6 months

Answer 1

Engerix®

Question 2

HBV Vaccine for peds greater than 1 year old and 3 doses at 0, 1, 6 months

Answer 2

Recombivax®

Question 3

HBV Vaccine for ages ≥ 18 and 2 doses at 0, 1 months

Answer 3

Heplisav-B®

Question 4

When do you initiate HBV treatment?

Answer 4

Anyone with active HBV defined as:
•HBV DNA > 2,000 IU/mL
•ALT ≥ 2x ULN and/or evidence of advanced fibrosis

Anyone with cirrhosis

Question 5

Pegylated Interferon dosing

Answer 5

180 mcg subcutaneously weekly x 48 weeks

Question 6

Pegylated Interferon AE’s

Answer 6

Flu-like symptoms, 
fatigue, 
mood disturbances, 
cytopenias (WBC, RBC, platelet), 
autoimmune disorders (adults), 
anorexia and weight loss (children)

Question 7

Pegylated Interferon Contraindications

Answer 7

Autoimmune disease, 
uncontrolled psychiatric disease, 
cytopenia, 
severe cardiac disease, 
uncontrolled seizures,
decompensated cirrhosis

Question 8

Entecavir (Baraclude®) MOA

Answer 8

guanosine nucleoside analog that inhibits HBV replication by 3 different steps:

• Priming of HBV DNA polymerase
• Reverse transcriptase
• HBV DNA synthesis

Question 9

Entecavir (Baraclude®) dosing

Answer 9

0.5 mg tablet daily

**1 mg tablet daily (if lamivudine experienced or has decompensated cirrhosis)

Question 10

Tenofovir Disoproxil Fumarate (Viread®) MOA

Answer 10

MOA: nucleotide analog that inhibits HBV replication by HBV polymerase

Question 11

Tenofovir Disoproxil Fumarate (Viread®) dosing

Answer 11

300 mg tablet daily with eCrCl > 50 ml/min

Question 12

Tenofovir Disoproxil Fumarate (Viread®) AE’s

Answer 12

Adverse Effects: nephropathy, osteomalacia, lactic acidosis, Fanconi syndrome

Question 13

Tenofovir Alafenamide ( Vemlidy®) MOA:

Answer 13

nucleotide analog that inhibits HBV replication by HBV polymerase

Question 14

Tenofovir Alafenamide ( Vemlidy®) Adult Dose:

Answer 14

25 mg tablet daily WITH FOOD

Question 15

Tenofovir Alafenamide ( Vemlidy®) Adverse Effects

Answer 15

Less extracellular distribution compared to TDF so ↓ AEs

Lactic acidosis

Question 16

Non-preferred Treatment Options in Hep B

Answer 16

Lamivudine (Epivir®)

Adefovir (Hepsera®)

Telbivudine (Tyzeka®)

Question 17

Special Pop Cirrhosis:

Answer 17

All cirrhotic patients should be treated

Decompensated patients should be evaluated for a liver transplant

Entecavir and tenofovir disoproxil fumarate (TDF) are preferred for decompensated patients

Treatment is continued indefinitely

Question 18

Special Pop HCV Co-infection:

Answer 18

Speeds up the progression of liver disease

All patients should be screened of HCV

Reactivation of HBV can occur while on HCV treatment

• May require HBV prophylaxis
• Black box warning for direct acting antiviral (DAA) medications for HCV

Question 19

Special Pop HDV Co-infection

Answer 19

Requires HBV infection

Nucleos(t)ide analogs (NAs) have not demonstrated efficacy against HDV

Pegylated interferon is the drug of choice

May add NAs if HBV is not controlled

Limited data on treating HDV as it is not commonly seen

Question 20

Special Pop HIV Co-infection

Answer 20

Initiation of antiretroviral therapy is strongly recommended

Therapy should include tenofovir alafenamide or tenofovir disoproxil fumarate
Regimen must include 2 agents with activity against HBV and HIV (tenofovir + emtricitabine or lamivudine)

Remember entecavir has some but not reliable activity against HIV

Question 21

Special Pop Pediatrics

Answer 21

Most do not meet the criteria for treatment
Lamivudine and entecavir are approved for children ≥ 2 years
Pegylated interferon is approved for children ≥ 1 year
Tenofovir disoproxil fumarate (TDF) is approved for children ≥ 12 years

Question 22

Special Pop Pregnancy

Answer 22

Major cause of transmission
If HBV DNA is > 200,000 IU/mL, then TDF is recommended in the 3rd trimester
Infants should be vaccinated and receive hepatitis B immunoglobulin (HBIG) within 12 hours of birth