Basics
#&%!
Presentations
Classic Tx
Modern Tx
100
The definition of chronic hepatitis
What is hepatic inflammation and necrosis for at least 6 months?
100
Single best lab correlate for level of liver injury and risk of progression (cirrhosis and HCC)
What is HBV DNA level?
100
Perinatal HBV infections have _________ levels of HBV replication and _________ levels of liver injury, typically.
What are high and negligible/low. This is mostly seen in Asian countries. Lifetime risk for cirrhosis and HCC are high, despite the benign appearance of liver disease in these patients)
100
The first therapy approved for chronic Hep B
What is interferon-alpha?
100
Once a week injectable option of treatment for chronic Hep C
What is PEG INF
200
3 ways of classifying hepatitis
What are Cause, grade (histologic activity), and stage (degree of progression)?
200
The chance of developing chronic hep B infection if infected at birth
What is 90%?
200
Although HBV DNA levels are lower and more readily suppressed by therapy in this subgroup, achieving sustained response allowing discontinuation of therapy, is less likely.
What is HBeAg negative patients
200
The first nucleoside analogue, an inhibitor of reverse transciptase
What is Lamivudine?
200
T/F Clinical trials indicate that combination therapy is superior to montherapy
False. There is insufficient evidence to recommend combination therapy as first-line therapy for all patients with chronic hepatitis B. Limited combined therapy arms show no advantage and show efficacy equal to the most potent component of the therapy. Combination therapy can be used in those coinfected with human immunodeficiency virus and HBV who are on antiretroviral therapy, those who have undergone liver transplantation, and those with drug-resistant HBV infection.
300
Name 1 of the two grading and staging scoring systems
What is Histologic activity index (HAI) – in US or METAVIR – in Europe
300
The chance of developing chronic hep B infection if infected as a young adult
What is 1%?
300
The most common symptom and most common feature of advanced chronic hepatitis
What are fatigue and jaundice?
300
Telbivudine is quite potent, however, it has very limited clinical use because…
Patients developed resistance at high rates (22% at 2 years)
300
The three therapies approved as first line therapy for chronic Hep B
What are PEG IFN, entecavir, and tenofovir
400
Name the 2 of 3 categories used for histologic staging of chronic hepatitis
What are: Periportal necrosis, Intralobular necrosis, and Portal inflammation?
400
The two phases of HBV replication
What are: 1. Replicative phase – presence of HBeAg andHBV DNA levels greater than 10^5 virons/ml 2. Nonreplicative phase – Absence of HBeAg and apperance of anti-HBe and virons less than 10^3
400
Name "Meltzer's triad" and what it classically signifies.
What is purpura, arthralgias and weakness due to cryoglobulinemia (type II & III primarily)
400
Why is Lamivudine is still used?
Because Lamivudine is the cheapest therapy for HBV and is therefore still widely in developing and third world countries
400
A potent acyclic nucleotide analogue used to treat HIV and Hep B.
What is Tenofovir dioproxil fumarate.
500
Typical severity of the acute of hepatitis B infection in those that develop chronic hepatitis B
What is subclinical/low severity?
500
Likelihood in a patient with HBeAg chronic hepatitis B converting spontaneously (moving to nonreplicative phase)
What is 10-15% per year
500
Name three antigen antibody related complications of HBV chronic infection.
What are arthralgias, arthritis, leukocytoclastic vasculitis, glomerulonephritis, and generalized vasculitis (polyarteritis nodosa)?
500
3 or more classic symptoms of interferon-alpha therapy BONUS: The single irreversible side effect of interferon-alpha
What are “flu-like” symptoms, merosuppression, emotional lability, autoimmune reactions, and others such as alopecia, rashes, diarrhea, and neuropathies. What is autoimmune thyroiditis
500
Two advantages of Tenofovir
What are: 1. A very good safety profile (negligible renal tox and mild reduction in bone density), but creatinine monitoring is still recommended. 2. No known resistance, making it great against all known drug resistant strains
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