p.17
Treatment goals for chronic hepatitis B
Who typically receives treatment for chronic HBV infection?
Individuals with high levels of circulating HBV DNA and alanine aminotransferase elevations, or those with cirrhosis.
p.1
Differences between HBV and HCV
What is a notable difference between HBV and HCV regarding vaccination?
HBV is a vaccine-preventable illness, whereas no vaccine is available to prevent HCV.
p.2
Treatment goals for chronic hepatitis B
What does seroconversion from HB eAg to anti-HB e indicate?
A positive treatment outcome in HBV infection.
p.10
Direct-acting antiviral agents (DAAs) for HCV
What are NS5A inhibitors used for?
They are direct-acting antiviral agents (DAAs) for treating hepatitis C.
p.4
Mechanism of action of interferons
What receptors do interferons bind to?
Tyrosine kinase receptors.
p.15
Treatment goals for chronic hepatitis B
Can current HBV therapies achieve a complete cure?
No, they cannot achieve a complete cure.
p.17
Treatment goals for chronic hepatitis B
How does the approach to HBV therapy differ between children and adults?
Most children have normal alanine aminotransferase levels and do not require treatment.
p.12
Sofosbuvir and its role in HCV treatment
What role does the triphosphate form of Sofosbuvir play in HCV treatment?
It is incorporated by HCV RNA polymerase into elongating RNA strands, resulting in chain termination.
p.9
Ribavirin and its effects in hepatitis treatment
What is ribavirin used for in hepatitis treatment?
Ribavirin is an antiviral medication that is often used in combination with other drugs to treat hepatitis C.
p.6
Adverse effects of interferon alfa
What cardiovascular issues can arise from interferon alfa?
Cardiotoxicity with hypotension and tachycardia.
p.17
Treatment goals for chronic hepatitis B
Is there a specific treatment for acute hepatitis B infection?
No, it often resolves spontaneously.
p.7
Drugs used to treat chronic hepatitis B
What type of drug is Entecavir?
A guanosine nucleoside analog.
p.6
Adverse effects of interferon alfa
What is a common flu-like syndrome associated with interferon alfa?
Headache, fevers, chills, myalgias, and malaise occurring within 6 hours in more than 30% of patients.
p.1
Differences between HBV and HCV
Are current treatments for HBV completely curative?
No, current treatments for HBV are not completely curative.
p.2
Treatment goals for chronic hepatitis B
How does treatment for HBV aim to affect liver disease progression?
By slowing the progression of liver disease.
p.8
Treatment of hepatitis C infection
How is sustained viral response (SVR) defined?
Absence of detectable viremia 24 weeks after completion of therapy or no measurable HCV RNA in blood following cessation of treatment.
p.7
Adverse effects of interferon alfa
What serious conditions may occur in patients with decompensated cirrhosis receiving Entecavir?
Lactic acidosis and severe hepatomegaly with steatosis.
p.5
Direct-acting antiviral agents (DAAs) for HCV
What has largely replaced PegIFN - α2 a for the treatment of HCV?
All oral direct-acting antivirals (DAAs).
p.5
Drugs used to treat chronic hepatitis B
What type of cancer is interferon alfa used to treat?
AIDS-related Kaposi’s sarcoma.
p.5
Drugs used to treat chronic hepatitis B
What neoplasms can be treated with interferon alfa?
Hairy cell leukemia, chronic myelogenous leukemia, and malignant melanoma.
p.17
Differences between HBV and HCV
What type of virus is the Hepatitis B virus (HBV)?
A small, enveloped, partially double-stranded DNA virus.
p.4
Mechanism of action of interferons
What is the primary function of IFN-α?
To be produced by nearly all cells in response to viral infection and various stimuli.
p.7
Drugs used to treat chronic hepatitis B
What is required for Entecavir to be effective?
Intracellular phosphorylation.
p.11
Direct-acting antiviral agents (DAAs) for HCV
Which NS5A inhibitors are mentioned?
Daclatasvir, Elbasvir, Ledipasvir, Ombitasvir, Velpatasvir, and Pibrentasvir.
p.10
Direct-acting antiviral agents (DAAs) for HCV
What type of inhibitor is Dasabuvir?
It is an NS5B non-nucleoside polymerase inhibitor.
p.3
Drugs used to treat chronic hepatitis B
Name a class of oral medications used for chronic hepatitis B treatment.
Nucleoside/nucleotide analogues.
p.5
Drugs used to treat chronic hepatitis B
What is PegIFN - α2 a approved for?
Treatment of hepatitis B and C.
p.9
Mechanism of action of interferons
What role does interferon play in the treatment of hepatitis C?
Interferon is used to boost the immune response against the hepatitis C virus.
p.1
Drugs used to treat chronic hepatitis B
What is the success rate of pegIFN-α in treating Hepatitis D?
It is successful in only 20% – 35% of patients.
p.3
Drugs used to treat chronic hepatitis B
Name two forms of Tenofovir used in hepatitis B treatment.
Tenofovir Disoproxil and Tenofovir Alafenamide.
p.15
Treatment goals for chronic hepatitis B
How is a functional cure for HBV defined?
As undetectable HBV DNA with seroconversion from HBsAg to anti-HBs.
p.4
Mechanism of action of interferons
What stimuli can induce the production of IFN-α?
Viral infection, double-stranded RNA, and certain cytokines (e.g., IL-1, IL-2, TNF).
p.14
Ribavirin and its effects in hepatitis treatment
What type of viruses is Ribavirin effective against?
Many DNA and RNA viruses, including influenza A & B, RSV, HCV, and HIV.
p.8
Treatment of hepatitis C infection
What indicates a cure of HCV?
Achievement of sustained viral response (SVR).
p.7
Adverse effects of interferon alfa
What are some potential adverse effects of Entecavir?
Headache, fatigue, dizziness, nausea, and upper abdominal pain.
p.4
Mechanism of action of interferons
How do interferons enhance the immune response?
By increasing phagocytic activity of macrophages and augmenting proliferation and survival of cytotoxic T cells.
p.6
Adverse effects of interferon alfa
What neurotoxic effects can interferon alfa cause?
Mood disorders, depression, somnolence, confusion, and seizures.
p.6
Adverse effects of interferon alfa
What are some hematological adverse effects of interferon alfa?
Myelosuppression, profound fatigue, myalgia, weight loss, rash, cough, and alopecia.
p.11
Direct-acting antiviral agents (DAAs) for HCV
What is the role of NS5A in HCV?
NS5A is essential for HCV RNA replication and assembly of new infectious viral particles.
p.16
Hepatitis C infection
What percentage of the world's population is infected with HCV?
Approximately 2%, or about 150 million people.
p.14
Ribavirin and its effects in hepatitis treatment
How is Ribavirin activated in the body?
It is phosphorylated intracellularly by host cell enzymes.
p.11
Adverse effects of interferon alfa
What is a significant concern regarding NS5A inhibitors?
They have clinically significant drug interactions due to metabolism by hepatic CYP450 isoenzymes and inhibition of P-glycoprotein.
p.8
Treatment of hepatitis C infection
What are the benefits associated with achieving SVR?
Improvement in liver histology, reduction in risk of end-stage liver disease and hepatocellular carcinoma, and regression of cirrhosis.
p.3
Drugs used to treat chronic hepatitis B
What is the role of Tenofovir in hepatitis B treatment?
It is an oral nucleoside/nucleotide analogue used to treat chronic hepatitis B.
p.6
Adverse effects of interferon alfa
How can interferon alfa affect autoimmune diseases?
It can induce autoantibodies, causing exacerbation or unmasking of autoimmune diseases, particularly thyroiditis.
p.12
Sofosbuvir and its role in HCV treatment
What is Sofosbuvir?
A medication administered in combination with several other anti-HCV medications.
p.12
Sofosbuvir and its role in HCV treatment
How is Sofosbuvir metabolized in cells?
It is converted to its active triphosphate form.
p.11
Direct-acting antiviral agents (DAAs) for HCV
What do NS5A inhibitors do?
They inhibit both viral RNA replication and virion assembly.
p.7
Mechanism of action of interferons
What functions of HBV DNA polymerase does Entecavir inhibit?
Base priming, reverse transcription of negative strand, and synthesis of positive strand of HBV DNA.
p.7
Drugs used to treat chronic hepatitis B
Why is Entecavir considered a first-line agent for HBV?
Because of its potency, durability, and low development of resistance.
p.4
Mechanism of action of interferons
What are the effects of the JAK-STAT pathway activation by interferons?
Inhibition of viral penetration, translation, transcription, protein processing, maturation, and release.
p.9
Direct-acting antiviral agents (DAAs) for HCV
What are Direct-acting antiviral agents (DAAs)?
Medications used to treat hepatitis C infection by directly targeting the virus.
p.14
Adverse effects of interferon alfa
What are some other adverse effects of Ribavirin?
Depression, fatigue, irritability, rash, cough, insomnia, nausea, and pruritus.
p.5
Drugs used to treat chronic hepatitis B
Which infections can interferon alfa treat in immunocompromised patients?
H. simplex, H. zoster, and CMV infections.
p.12
Sofosbuvir and its role in HCV treatment
What is the pharmacologically active form of Sofosbuvir?
Its triphosphate form, known as GS-461203.
p.2
Treatment goals for chronic hepatitis B
What is a primary treatment goal for HBV using pegIFN-α or nucleoside/tide analogues?
To suppress HBV DNA replication.
p.1
Differences between HBV and HCV
Can HCV be cured with treatment?
Yes, HCV can be cured with effective treatment.
p.10
Sofosbuvir and its role in HCV treatment
What is the role of Sofosbuvir?
It is an NS5B nucleoside polymerase inhibitor used in hepatitis C treatment.
p.3
Drugs used to treat chronic hepatitis B
What is an injectable drug used to treat chronic hepatitis B?
Pegylated Interferon alfa - 2a or Interferon alfa - 2b.
p.14
Adverse effects of interferon alfa
What is a common adverse effect of Ribavirin?
Dose-dependent hemolytic anemia in 10-20% of patients.
p.6
Adverse effects of interferon alfa
What are some reversible sensory adverse effects of interferon alfa?
Hearing loss, tinnitus, retinopathy, and pneumonitis.
p.6
Adverse effects of interferon alfa
What type of hepatic changes can occur with interferon alfa treatment?
Transient hepatic enzyme elevations.
p.11
Direct-acting antiviral agents (DAAs) for HCV
How are NS5A inhibitors typically administered?
They are coformulated with other direct-acting antivirals.
p.14
Mechanism of action of interferons
What do the mono- and triphosphate derivatives of Ribavirin inhibit?
GTP and viral RNA synthesis, as well as viral RNA-dependent polymerase of certain viruses.
p.16
Hepatitis C infection
What are some symptoms of decompensated liver disease?
Ascites, hepatic encephalopathy, or variceal bleeding.
p.13
Sofosbuvir and its role in HCV treatment
How is sofosbuvir generally tolerated?
Well tolerated, with side effects observed mainly when used in combination with other antiviral drugs.
p.2
Treatment goals for chronic hepatitis B
What is one of the risks that HBV treatment aims to reduce?
The risk for complications, including hepatocellular carcinoma.
p.10
Direct-acting antiviral agents (DAAs) for HCV
What is the function of NS3/4A protease inhibitors?
They inhibit the protease enzyme necessary for hepatitis C virus replication.
p.7
Treatment goals for chronic hepatitis B
What can happen to patients who discontinue anti-HBV therapy?
Severe acute exacerbations of HBV may occur.
p.14
Adverse effects of interferon alfa
Is Ribavirin teratogenic?
Yes, Ribavirin is teratogenic.
p.5
Drugs used to treat chronic hepatitis B
In which neurological condition is interferon alfa used?
Relapsing-type multiple sclerosis.
p.13
Sofosbuvir and its role in HCV treatment
What is the role of P-glycoprotein (P-gp) in the pharmacokinetics of sofosbuvir?
Sofosbuvir is a substrate of the drug transporter P-gp, and potent inducers of P-gp in the intestine can decrease sofosbuvir blood concentration.
p.13
Adverse effects of interferon alfa
In which patients is bradycardia more likely to occur when taking sofosbuvir?
In patients also receiving beta blockers or those with underlying cardiac comorbidities.
p.13
Sofosbuvir and its role in HCV treatment
Is sofosbuvir a CYP substrate, inhibitor, or inducer?
No, it is not a CYP substrate, inhibitor, or inducer, which gives it a low potential for drug interactions.
