Viral Hepatitis

PHRM 520
Wesley D. Kufel, PharmD, BCPS, AAHIVP
Clinical Assistant Professor
November 19, 2018
Learning Objectives
• Identify the routes of transmission for viral hepatitis
• Discuss risk factors and screening populations for viral hepatitis
• Describe the clinical presentation of viral hepatitis
• Recommend appropriate vaccines for Hepatitis A and Hepatitis B
• Recommend appropriate non-pharmacologic and pharmacologic
interventions for patients with viral hepatitis
• Identify adverse effects, drug interactions, and clinical pearls with
pharmacologic agents for Hepatitis C
• Discuss counseling points and monitoring parameters for
pharmacologic agents for viral hepatitis
 Introduction
• Inflammation of the liver with viral etiology

• 5 primary types of viral hepatitis

• Hepatitis A (fecal-oral transmission)
• Hepatitis B (blood-borne transmission)
• Hepatitis C (blood-borne transmission)
• Hepatitis D (delta) (blood-borne transmission)
• Common co-infection with hepatitis B
• Hepatitis E (fecal-oral transmission)
Clinical Terms
• Acute viral hepatitis
• Symptoms last less than 6 months
• Chronic viral hepatitis
• Symptoms last for at least 6 months
• Cirrhosis
• Liver attempts to regenerate in presence of inflammation à fibrosis (scar
tissue) à loss of liver function
• Hepatocellular carcinoma
• Primary liver malignancy
Comparison of Types of Viral Hepatitis
Hep A - acute, no chronic phase
Hep B/C - can have chronic phase
Hepatitis A (HAV)
Epidemiology, Risk Factors, Screening, Clinical Presentation, Diagnosis, Vaccination,
Treatment
HAV Background
• Single stranded RNA virus

• Often self-limiting (ACUTE)

• NO CHRONIC PHASE!
• Rarely fatal
• Majority recover fully with lifelong immunity

• Decline in reported Hep A cases in the United States

• Largely due to vaccination
• Rare reported cases of outbreaks

• More common in low socioeconomic countries/regions

• Transmission
• Fecal-oral route
• Person to person
• Ingestion of contaminated food and water
 Risk Factors for HAV

Poor sanitary Household/close

Overcrowding
conditions contacts

International Sexual contacts

Immigration travel (Central and especially MSM
South America) and PWID
MSM = men sex men
HAV Pathophysiology
• Average Incubation period
28 days
• Range 15-50 days
HAV Clinical Presentation
• Signs & Symptoms
• Fever (sign)
• Fatigue (symptom)
• Malaise (symptom)
• Diarrhea (sign)
• Nausea (symptom)
• Vomiting (sign)
• Loss of appetite/anorexia (symptom)
• Dark colored urine (sign)
• Right upper quadrant abdominal pain (symptom)
• Physical Exam
• Possible hepatomegaly
• Icteric skin, sclera, and secretions
HAV Diagnosis and Lab Abnormalities
• Diagnosis à Clinical Diagnosis
• Positive HAV IgM Antibody plus clinical presentation
• Detectable 5-10 days prior to symptoms
• Anti-HAV IgG replaces IgM à indicates host immunity

• Lab abnormalities
• Elevated ALT/AST
• Elevated serum bilirubin
• Elevated alkaline phosphatase
HAV Serological Course
HAV Treatment
• Supportive care

• Self-limited

• Consider holding potentially hepatoxic medications

HAV Prevention
• GOAL: Anti-HAV IgG Antibody POSITIVE to give IMMUNITY
• Prior exposure to HAV give lifelong immunity
• Vaccination
• Immunoglobulin
• Handwashing
• Avoid tap water in areas with poor sanitation
• Avoid undercooked foods in areas with poor sanitation
HAV Immunization Indications
• Inactivated vaccine à intramuscular administration
• Part of the routine childhood vaccination schedule (added in 2006)
• Screening populations (at risk)

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HAV Vaccine Dosing
• Havrix (HAV vaccine)
• Administer one dose followed by a second dose in 6-12 months (0, 6-12 months)
• TWO TOTAL DOSES
• Intramuscular administration
• Adults and pediatrics - same dosing

• Twinrix (HAV plus HBV vaccine)

• Administer one dose followed by a second dose at 1 month then a third dose at 6
months (0, 1, 6 months)
• Intramuscular
• Adults only
• Accelerated dosing schedule available
Specific Prophylaxis Scenarios
don’t need to know - more of FYI

• Travel to high risk area (Central and South America)

• Individuals < 40 years of age
• Give x1 dose of HAV prior to departure
• Individuals > 40 years, immunocompromised, or chronic liver disease
• Give x2 doses of HAV vaccine prior to departure or x1 HAV vaccine PLUS HAV immune
globulin
• Post-exposure prophylaxis
• Close personal contacts of individual with lab-confirmed HAV infection
• Child care centers (>1 HAV case)
• Food handlers
HAV Summary
• HAV is transmitted via fecal-oral route

• Risk factors
• International travel to high risk areas (Central and South America)
• Poor sanitation and hygiene
• Overcrowded
• Contaminated food and water

• HAV is vaccine preventable and is a recommended childhood vaccine

• 2 dose series (0, 6-12 months)

• Treatment is supportive care

Hepatitis B
Epidemiology, Risk Factors, Screening, Clinical Presentation, Diagnosis, Vaccination,
Treatment
HBV Background
• Double stranded DNA virus

• CAN develop a CHRONIC phase

• Highly infectious
• ~50-100x more than HIV
• Common co-infection with HIV and HCV
• Major public health issue
• Bloodborne transmission
• Parenterally, sexually, and perinatally
• Stable in environment for at least 7 days

• Chronic HBV à cirrhosis à hepatocellular carcinoma

 Risk Factors for HBV (Screening Populations)
• Parenterally
• Injection drug use
• Open areas of skin

• Sexually
• Semen and vaginal fluid
• Especially multiple sex partners, history of STDs, or MSM

• Perinatal transmission
• Less common in United States
• HBV vaccine is first vaccine to be administered to newborn

• Other populations at risk due to these modes of transmission

• Hemodialysis
• Pregnancy
• Patients receiving immunosuppressive therapy
• HIV or Hepatitis C
• Incarceration
HBV Pathophysiology
HBV Clinical Presentation
• Similar to clinical presentation of other viral hepatitis
Interpretation of HBV tests Know for exam

• Hepatitis B surface antigen (HBsAg)

• Protein on surface of HBV
• Presence indicates the person is INFECTIOUS

(not antigen)
• Hepatitis B surface antibody (anti-HBs)
• Indicates recovery or immunity from HBV
• Will be positive if previously infected or
vaccinated
• Hepatitis B core antibody (anti-HBc)
• Appears at onset of ACUTE HBV infection
• Persists for life – indicates previously infected
IgM detectable in first 6 months

• IgM antibody to HBV core antigen

Detectable HBsAg > • Indicates recent infection with HBV (< 6
6 months months) – ACUTE infection
Which of the following scenarios indicates
immunity to Hepatitis B due to prior
immunization?
A. HbsAg positive, anti-Hbs negative, anti-Hbc positive
B. HbsAg negative, anti-Hbs positive, anti-Hbc positive
C. HbsAg negative, anti-Hbs positive, anti-Hbc negative
D. HbsAg negative, anti-Hbs negative, anti-Hbc negative
Which of the following indicates current
infection with HBV?
A. HbsAg positive, anti-Hbs negative, anti-Hbc positive
B. HbsAg negative, anti-Hbs positive, anti-Hbc positive
C. HbsAg negative, anti-Hbs positive, anti-Hbc negative
D. HbsAg negative, anti-Hbs negative, anti-Hbc negative
Which of the following indicates immunity
from a prior infection?
A. HbsAg positive, anti-Hbs negative, anti-Hbc positive
B. HbsAg negative, anti-Hbs positive, anti-Hbc positive
C. HbsAg negative, anti-Hbs positive, anti-Hbc negative
D. HbsAg negative, anti-Hbs negative, anti-Hbc negative
Chronic Hepatitis B
• If HBsAg positive then order:
• HBeAg (antigen that is marker of replication/infectivity) and serum HBV DNA
• Interpretation of serologic tests are beyond scope of this class
• Determines if patients should be treated with antiviral therapy

• Chronic hepatitis B à cirrhosis à hepatocellular carcinoma à death

• NOT curable à GOAL is to suppress HBV replication and prevent

progression to cirrhosis and hepatocellular carcinoma
• Prevent disease transmission
• Avoid further liver damage by avoiding/minimizing alcohol consumption
Pharmacologic Therapy for Chronic HBV
• Tenofovir
• Nucleoside reverse transcriptase inhibitor (NRTI)
• First-line treatment due to efficacy and low likelihood of resistance developing
• Commonly used agent for HIV

• Entecavir
• Nucleoside reverse transcriptase inhibitor (NRTI)
• First-line option due to efficacy and low likelihood of resistance developing
• Well-tolerated
• More effective than lamivudine and effective in lamivudine-resistant viruses

• Lamivudine
• Nucleoside reverse transcriptase inhibitor (NRTI)
• 2nd line treatment due to reduced efficacy and more resistance
• Commonly used agent for HIV

• **Will learn pharmacology next semester

HBV Vaccination Indications
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Diabetics

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HBV Vaccines Available
• Intramuscular administration
• Heplisav
• 2-dose series
• Recombivax and Engerix
• 3-dose series
Which of the following vaccines are
scheduled as two-doses?
A. Heplisav-B
B. Havrix
C. Twinrix
D. Recombivax
E. A and B only
F. C and D only
HBV Reactivation with Immunosuppressive Therapy
• HBV testing in patients who are planned to receive
immunosuppressive therapy
• HBsAg
• Anti-HBc
• Positive results require further testing

• Immunosuppressive regimens – different levels of risk

• Anti-CD 20 agents (i.e. rituximab) – FDA Boxed Warning for reactivation
among HBsAg + or anti-HBc + patients
• TNF inhibitors (i.e. infliximab)
• Glucocorticoids (prednisone 20 mg equivalents for > 4 weeks
• Patients undergoing transplant
• Patients receiving chemotherapy
HBV Summary
• HBV is transmitted via bloodborne route
• Parenteral, sexual, and perinatal transmission
• Chronic HBV (HsAg (+) > 6 months à cirrhosis à hepatocellular
carcinoma à death
• Interpretation of serologic tests is key to determine HBV infectivity
• Chronic HBV often requires treatment to suppress HBV
• Entecavir and tenofovir first-line
• HBV vaccine is the FIRST vaccine administered to newborns
• Heplisav (0, 1 months) and Recombivax and Engerix (0, 1, 6 months)
• HBV testing required in patients receiving certain immunosuppressive
agents
Which of the following vaccines are
administered via the intramuscular route?
• Havrix
• Energix
• Recombivax
• Twinrix
• All of the above
Which of the following is used to treat
chronic hepatitis B infection?
A. Ribavirin
B. Entecavir
C. Elbasvir
D. Sofosbuvir
E. Velpatasvir
Hepatitis C
Epidemiology, Risk Factors, Screening, Clinical Presentation, Diagnosis, Treatment
HCV Background
• Single-stranded RNA virus

• Differentiated into 6 genotypes (1 – 6) and subtypes

• Genotype 1a and 1B most common in the United States
• Genotype 3 is most challenging to manage

• Approximately 3.2 million people chronically infected with HCV

• 5x more common than HIV infection
• Common co-infection with HBV and HIV
• Leading cause of liver transplantation

• Since 2013, HCV is a largely CURABLE disease

Risk Factors for HCV (Screening Populations)
• Spread through contaminated blood

“Baby Boomers” – non-modifiable risk factor

Most common risk factor

Especially MSM & traumatic sex
Which type of viral hepatitis is not associated
with a CHRONIC phase?
A. Hepatitis A
B. Hepatitis B
C. Hepatitis C
D. All of the above
E. None of the above
HCV Pathophysiology
• Acute infection can lead to chronic
• Detectable HCV RNA > 6 months
• Up to 85% of patients with acute infection can develop into chronic phase
Which the following patients would be
appropriate for HCV screening?
A. Recent travel to Mexico for a month - risk factor for Hep A
B. A 58-year-old healthy male
C. Injection drug user
D. B and C
E. All of the above
HCV Diagnostic Tests and Interpretation
• Positive HCV Ab DOES NOT indicate immunity (different than HBV)
• Can be reinfected if reexposed
• Should order HCV RNA viral load if negative HCV Ab and high
suspicion and/or exposure occurred within 6 months
• May not have had time for AB to develop
Which of the following types of viral hepatitis
is transmitted via contaminated blood?
A. Hepatitis A
B. Hepatitis B
C. Hepatitis C
D. B and C
E. All of the above
HCV Clinical Presentation
• Many asymptomatic
• Incidental finding from screening populations

• Fatigue
• Most common symptom
• Elevated LFTs
• Right upper quadrant abdominal pain
• Nausea
• Poor appetite/anorexia
• Hepatomegaly on physical exam

• Advanced disease
• Splenomegaly, spider nevi, palmar erythema,
• Chronic inflammation of the liver à fibrosis (altered perfusion) à cirrhosis
• Cirrhosis à End-stage liver disease à hepatocellular carcinoma
Which of the following ARE NOT consistent with
the clinical presentation finding with viral
hepatitis?
A. Fatigue - most common
B. Elevated LFTs
C. Right upper quadrant pain - Right upper is where liver is located
D. Elevated blood pressure
E. Fever- more common in acute, but still associated with viral
F. Jaundice
Risk Factors for Advanced Liver Disease with HCV
• Alcohol abuse
• Obesity
• HIV or HBV co-infection
• HCV Genotype 3 (non-modifiable risk factor)

• Appropriate nonpharmacologic counseling essential

• Decrease and/or abstain from alcohol consumption
• Weight loss and lifestyle modifications
• HIV and HBV prevention mechanisms
HCV Treatment Goals
• Cure chronic HCV infection
• Achieve sustained virologic response (SVR) at 12 weeks AFTER the completion
of therapy SVR12

• Treatment is recommended in ALL patients

• Includes patients who inject drugs, HIV, HBV coinfection
• Except those with short life expectancy (< 12 months)
 don’t need to know
Baseline Evaluation of Chronic HCV
• HCV-related labs
• HCV RNA Viral Load
• Genotype
• Resistance Testing (if appropriate)

• Liver-related labs
• Liver function assessment
• INR, albumin, platelets (CBC)
• Liver inflammation assessment
• ALT, AST
• Cirrhosis
• Determined via labs or imaging
modalities 1 Point 2 Points 3 Points
• FIB-4 or APRI Encephalopathy None Mild-Moderate Severe
• Stage of cirrhosis Ascites None Mild-Moderate Severe (refractory
(responds to diuretics) to diuretics)
• Child-Pugh score Total bilirubin <2 2–3 >3
• Compensated (Child-pugh (mg/dL)
score A) vs Decompensated Albumin (g/dL) > 3.5 2.8–3.5 < 2.8
(Child-pugh score B and C) INR < 1.7 1.7–2.3 > 2.3
• Affects treatment selection
Which of the following is a reason to NOT
treat chronic HCV?
A. Injection drug user
B. HIV co-infection
C. HBV co-infection
D. Short-life expectancy (< 12 months)
E. Previous failure with pegylated interferon
Pre-Direct Acting Antiviral Era
• Low treatment success/cure rates

• Pegylated interferon - low treatment success, lots of side effects

• Intramuscular administration
• MANY side effects
• Neuropsychiatric effects
• Flu-like symptoms
• Fatigue

• Ribavirin
• Still used in combination with DAAs in certain populations including some patients
with cirrhosis, resistance mutations, or treatment-experience
Ribavirin
• Purine nucleoside analog
• Mechanism of action is unclear
• Typically used in more difficult to treat patients
• Advanced cirrhosis, previous treatment failure/experience, resistance
• Weight-based dosing (often requires multiple capsules to administer dose)
• 1000 mg if <75 kg
• 1200 mg if >75 kg
• Dose adjustments based on renal function and hemoglobin
• Adverse effects
• Hemolytic anemia (must closely monitor hemoglobin/hematocrit)
• Fatigue
• Rash, itching
• Nausea
• Teratogenic (Pregnancy category X)
• Pregnancy test required prior to use
• Requires 2 forms of contraception while using
• Avoid in males with pregnant partners
 all used in fixed dose combination tablets
• Harvoni
Direct Acting Antivirals • Ledipasvir/sofosbuvir
very effective drug!
CURE RATES > 90%!!P for protease, p for -previr • Zepatier
• Elbasvir/grazoprevir know
Class Common Generic Drug these 4
Suffix Name • Epclusa
NS3/4A Protease -previr Grazoprevir • Sofosbuvir/velpatasvir
Inhibitors Voxilaprevir • Mavyret
Glecaprevir
• Glecaprevir/pibrentasvir
NS5A Inhibitors -asvir Ledipasvir • Vosevi
Elbasvir
Velpatasvir
• Sofosbuvir/velpatasvir/voxila
Pibrentasvir previr
• Only used for patients who
NS5B Polymerase -buvir Sofosbuvir
Inhibitors
fail therapy with DAAs
DAA Mechanism of Action
 DAA Adverse Effects

Drug Therapy Adverse Effects

Elbasvir/grazoprevir Headache; nausea
Glecaprevir/pibrentasvir Headache; fatigue • Well-tolerated
Ledipasvir/sofosbuvir Headache; fatigue
Sofosbuvir/velpatasvir Headache; fatigue • FDA Boxed
Sofosbuvir/velpatasvir/ Headache; fatigue; warning: Risk of
voxilaprevir diarrhea HBV reactivation
with DAA use
Brand Name Drug Formulation: Generic Dose GT Indication Use in Cirrhosis Use in Renal
Name and Strength (Drug Insufficiency
Class)
Epclusa
DAA Considerations
Two-drug tablet containing
velpatasvir 100 mg (NS5A
inhibitor) and sofosbuvir
1 tablet daily with or GTs 1–6
without food
Compensated and
decompensated
cirrhosis (all CTP
Not recommended if
eGFR 30
mL/min/1.73 m2
400 mg classes)
Harvoni Two-drug tablet containing 1 tablet daily with or GTs 1, 4 Compensated and No
ledipasvir 90 mg (NS5A without food decompensated
inhibitor) and sofosbuvir cirrhosis (all CTP
400 mg classes)
Mavyret Two-drug tablet containing 3 tablets once daily GTs 1–6 Compensated Yes, including
glecaprevir 100 mg (NS3/4A with food cirrhosis (CTP class A) hemodialysis
PI) and pibrentasvir 40 mg Not recommended in
(NS5A inhibitor) CTP class B
Contraindicated in
CTP C
Vosevi Three-drug tablet 1 tablet daily with GTs 1–6 Compensated Not recommended if
containing voxilaprevir 100 food cirrhosis (CTP class A) eGFR 30
mg (NS3/4A inhibitor), mL/min/1.73 m2
velpatasvir 100 mg, Not recommended in
sofosbuvir 400 mg CTP class B or C
Zepatier Two-drug tablet containing 1 tablet daily with or GTs 1, 4 Compensated Yes, including
elbasvir (NS5A inhibitor) without food cirrhosis only (CTP hemodialysis
and grazoprevir (NS3/4A PI) class A)

Contraindicated in
CTP class B or C
 both contain A and B inhibitor
Specific Considerations for Use
• Harvoni (Ledipasvir/sofosbuvir)
• Convenient (one tablet daily with or without food)
• NOT recommended if eGFR < 30 ml/min/1.73m2 (NS5B inhibitor – sofosbuvir)
• Only approved for Genotype 1 and 4
• Ledipasvir requires acidic environment for absorption
• AVOID all acid-suppressive therapy if possible
• Omeprazole 20 mg (or equivalent) should be administered at same time
• Give H2RAs at same time or 12 hours apart
• Give antacids 4 hours after and stopped at least 8 hours before next dose
• Sofosbuvir and amiodarone drug interaction à symptomatic bradycardia (avoid)
Sofosbuvir - renal clearance (B can accumulate),
• Epclusa (Velpatasvir/sofosbuvir) interaction with Amiodarone
• Convenient (one tablet daily with or without food)
• NOT recommended if eGFR < 30 ml/min/1.73m2 (NS5B inhibitor – sofosbuvir)
• Approved for ALL genotypes (1-6)
• Ledipasvir requires acidic environment for absorption
Velpatasvir
• AVOID all acid-suppressive therapy if possible
• Omeprazole 20 mg (or equivalent) should be administered 4 fours before Epclusa and WITH FOOD
• Give H2RAs at same time or 12 hours apart
• Give antacids 4 hours after and stopped at least 8 hours before next dose
• Sofosbuvir and amiodarone drug interaction à symptomatic bradycardia (avoid)
 Both A and protease inhibitors

Specific Considerations for Use

• Elbasvir/grazoprevir (Zepatier)
• Convenient (1 tablet daily with or without food)
• Can be used in patients with renal impairment
• Approved for Genotype 1 and 4 only - same as Harvoni
• No acid requirements for absorption
• Resistance testing for Genotype 1a prior to treatment (requires longer
treatment duration and additional use of ribavirin)
• Protease inhibitors typically have more drug interactions

• Glecaprevir/pibrentasvir (Mavyret)
• 3 tablets once daily WITH FOOD
• Can be used in patients with renal impairment
• Approved for all genotypes (1-6)
• No acid requirements for absorption
• Offers 8 week treatment option - shorter than others (usually 12 wks)
• Protease inhibitors typically have more drug interactions
How to choose therapy?
• Genotype
• Mavyret and Epclusa are pan-genotypic
• Patient preference & tablet burden
• Mavyret is 3 tablets once daily with FOOD
• Acid-suppressive therapy
• Best to avoid if using ledipasvir or velpatasvir-containing regimens
• Renal insufficiency
• Avoid sofosbuvir-containing regimens if eGFR <30 ml/min/1.73m2
• Drug-drug interactions
• Sofosbuvir and amiodarone à symptomatic bradycardia
• Protease inhibitors often have more drug interactions
• Interaction checker: https://www.hep-druginteractions.org/checker
• Resistance testing
• Zepatier requires resistance testing prior to use for genotype 1a
• Insurance coverage
• Regimens typically cost $75,000-$100,000
• Presence of cirrhosis (beyond scope of class)
• Treatment naïve or treatment-experienced (beyond scope of class)
 Treatment
Harvoni
Durations (Treatment
Mavyret
Naïve)
Ledipasvir/sofosbuvir Velpatasvir/sofosbuvir Glecaprevir/pibrentasvir Elbasavir/grazoprevir
1a 12 weeks 12 weeks 8 weeks 12 weeks (resistance
*8 weeks if non-black, no testing)
HIV co-infection, or HCV
RNA < 6 million

1b 12 weeks 12 weeks 8 weeks 12 weeks

*8 weeks if non-black, no
HIV co-infection, or HCV
RNA < 6 million

2 X 12 weeks 8 weeks X
3 X 12 weeks 8 weeks X
4 12 weeks 12 weeks 8 weeks 12 weeks
5 or 6 X 12 weeks 8 weeks X

Mavyret and Harvoni are the only DAAs that offer an 8-week treatment regimen
Which of the following DAAs should be avoided if
possible with acid suppressive therapy?
A. Ledipasvir
B. Sofosbuvir
C. Velpatasvir
D. A and C only
E. All of the above
Which of the following DAAs should be avoided in
patients with renal impairment with eGFR < 30
ml/min?
A. Ledipasvir
B. Sofosbuvir
C. Velpatasvir
D. A and C only
E. All of the above
Which of the following DAAs are pan-
genotypic (genotype 1-6)?
A. Harvoni
B. Epclusa
C. Mavyret
D. Zepatier
E. A and D only
F. B and C only
Which of the following DAAs is correctly
paired to a clinical pearl?
A. Mavyret à One tablet once daily with or without food
B. Zepatier à Drug interaction with amiodarone
C. Harvoni à Requires baseline resistance testing for genotype 1a
D. Epclusa à Not recommended if eGFR <30 ml/min/1.73m2
Hepatitis C antibody remains positive even
after cure?
A. True
B. False
 Initial Work-up
1. Screen patient if risk factor present
2. If HCV Ab positive, check HCV RNA Viral Load
3. If HCV RNA Viral Load positive, this confirms chronic HCV (~>6 mos)
4. Perform genotype testing
5. Assess baseline labs and history
6. Start appropriate therapy based on patient-specific factors
7. Check HCV RNA viral load 4 weeks into treatment
1. Should be significantly reduced
8. Treat for appropriate duration (usually 8-12 weeks for treatment naïve)
9. Check if achieved sustained virologic response 12 weeks after end of treatment
(SVR 12)
10. Cured!
1. HCV Ab remains positive for life (does not indicate immunity)
2. Avoid risk factors for reinfection
 Barriers and Challenges to HCV Treatment
• Cost
• Insurance coverage
• Specialty pharmacy
• Access/delivery to HCV treatment
• Hospital admission
• Adherence
• Adverse effects
• Reinfection
HCV Vaccine
• DOES NOT EXIST!
 HCV Summary
• HCV is transmitted via contaminated blood
• Specific patient groups at risk and screening
• Baby boomers (1945-1965), PWID, HIV, MSM
• ~85% of patients infected with HCV develop chronic HCV
• DAAs result in cure rates >90%
• Specific factors influence treatment option
• Genotype, resistance, treatment history, renal function, drug interactions,
tablet burden
• Treatment duration is generally 8-12 weeks for treatment naïve
• No vaccine is available for HCV
Which of the following antibody results DO NOT
indicate immunity from its associated viral
hepatitis type?
A. Positive HAV IgG
B. Positive HBV Surface Ab
C. Positive HBV Core Ab
D. Positive HCV Ab
Which of the following is the first vaccine
administered to newborns?
A. Havrix
B. Energix
C. Twinrix
D. Hepatitis C vaccine
Which of the following types of viral hepatitis
is/are considered curable?
A. Hepatitis A
B. Hepatitis B
C. Hepatitis C
D. A and C only
E. All of the above
Which of the following is considered
teratogenic?
A. Entecavir
B. Tenofovir
C. Ribavirin
D. Sofosbuvir
E. Grazoprevir