-
how is HAV spread
- fecal-oral route
- person to person
- by ingestion of contaminated food/water
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which genus does HAV belong to
hepatovirus of the picornaviridae family
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what is the only know reservoir for the HAV
humans
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s/s of HAV
n/v, fatigue, malaise, RUQ pain, anorexia, pruritis
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what are the positive serum tests for HAV
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what prophylaxis vaccines are used for HAV and what is the dosing
- Havrix <18 0.5 ml 6-12mths apart (>19 1.0 ml)
- Vaqta
- twinrix >=18 1.0ml 0,1,6 mths
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which vaccine can be given for HAV postexposure prophylaxis
Immunoglobulin
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how is HBV transmitted
- sexually
- parenterally
- perinatally
-
HBV belongs to which family
hepadnaviridae
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which HBV genotype is associated with more severe liver injury
genotypes C
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when is HBsAg detectable
at the onset of clinical symptoms
-
what does anti HBsAg confer
immunity to the virusand clearance of HBsAg
-
what is HBeAg
marker of HBV replication and infectivity
-
what is HBcAg
promotes immune mediated cell death when expressed on hepatocytes
-
what are the diagnostic criteria for HBV
- HBsAg positive for > 6 mths
- elevated liver enzymes and HBV DNA > 20,000
- liver biopsy shows fibrosis or cirrhosis
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what are the vaccines used to prevent HBV
- recombivax
- comvax
- twinrix
- pediarix
- Hep B Ig
-
which HBV vaccines are for pediatric use only
-
Twinrix vaccines is used in which age groups
adults only
-
agents used for tx of chronic HBV
- INF alpha
- pegINF alpha
- lamivudine
- adefovir
- entacavir
- telbivudine
- tenofovir
-
-
-
-
-
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which INF has a more convenient dosing and sustained viral response
pegINF
-
in which pts should INF not be used in
pts with decompensated cirrhosis
-
when might a pt be switched from lamivudine tx to prevent resistance
after 2 yrs
-
how long should epivir tx last
until HBeAg seroconversion for HBeAg positive pts
-
epivir is not a first line tx for which type of HBV
HBeAg negative chronic HB
-
adefovir dose adjustments for pts with renal insufficiency
dosing interval should increase with renal insufficiency
-
adefovir should not be used in which age groups
in children
-
when should lamivudine be continued indefinitely
after the additioin of adefovir or tenofovir
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what should be monitored in pts with renal insufficiency
serum creatinine q3 mths and in pts on adefovir over 1 yr
-
telbivudine has a limited role in treating HB because
cases of myopathy and peripheral neuropathy have been reported. Also has a high rate of resistance
-
AE of tenofovir
- fanconi syndrome
- osteomalacia
- renal insufficiency
-
if a pt is on lamivudine or telbivudine and adds entacavir what should happen
lamivudine or telbivudine should be stopped to avoid entacavir resistance
-
how often should pts have their liver panel monitored when on antiHBV tx
q3 mths and HBV DNA every 3-6 mths
-
when should HBsAg be tested in pts who are HBeAg negative with persistently undetectable serum HBV DNA
q 6-12 mths
-
which HCV pts are ineligible for IFN tx
- decompensated hepatic disease
- hx of depression
- ANC < 1500, platelet < 90, Hgb < 10
- preexisting cardiac disease
-
what is the best predictor of long term response to HCV tx
sustained virologic response
-
what is a relapser
pt who has achieved an undetectable level of virus during a prior tx course of PEG/RBV and relapsed after tx was stopped
-
drugs used for the tx of HCV
- sofosbuvir (sovaldi)
- simeprevir (olysio)
- ribavirin (copegus, rebetol, ribasphere)
-
what is the black box warning for ribavirin
- hemolytic anemia
- teratogenicity (category X)
-
simeprevir is a substrate and weak inhibitor of which enzyme
- substrate of 3a4
- weak inhibitor of 1a2
-
which antiviral medication is not metabolized by p450 enzymes
sofosbuvir
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