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CC May 2016 Hepatitis B virus reactivation

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echoecho's version from 2016-07-31 18:56

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Question Answer
In 2013, there were 2,010 cases of acute hepatitis B reported, but since many infections are asymptomatic or NOT reported, it is estimated that the actual number is ____- fold greater?ten
In the US, it is estimated that _______ to ______ indivduals live with chronic hepatitis B infection?700,000; 1.4 million
Even in those who have serologic evidence of viral clearance, the virus remains ______ and can reactivate with __________?reactivate; immunosuppression
Hep B virus reactivation (HBVr) during and after ________ therapy can result in significant morbidity and mortality?immunosuppressive
What does the risk of reactivation depend on?1) the individual's serologic maranti-HBkers 2) type and duration of immunosuppresion
*** The AGA (American Gastroenterological Association) released guidlines in 2015 to define risk of reactivation and offer prophylaxis recommendation. What are these recommendations?The 2 markers necessary to determine risk of reactivation are 1) hepatitis B surface antigen (HBsAg) AND 2) hepatitis C core antigen (anti-HBc)
Are liver enzymes and other markers noted to be helpful in determining reactivation risk?no
List the guideline categories?1) high risk (> 10% anticipated incidence of HBVr) 2) moderate risk (1-10% anticipated incidence) 3) low risk (< 1% anticipated incidence)
What are the guidelines for treatment of an individual that is high-risk and has received immunosuppressive therapy?received prophylaxis for at least 6 months following discontinuation of immunosuppressive therapy (12 months for B-cell depleting therapy)
What are the guidelines for treatment of an individual that is moderate-risk and has received immunosuppressive therapy?receive prophylaxis for 6 months after discontinuation of immunosuppressive therapy
What are the guidelines for treatment of an individual that is low-risk and has received immunosuppressive therapy?recommends against prophylaxis
True or false? It is important to note that some patients are at increased risk if they are HBsAg negative?true
Give examples of high risk patients and the type of immunosuppressant therapy that is considered in the high risk group?1) +HBsAG / +anti-HBc OR -HBsAG / +anti-HBc (B cell depleting agents like rituximab (Rituxan) 2) +HBsAG/ +anti-HBc (Anthracycline derivatives (Doxorubicin {Adriamycin}) 3) +HBsAG / +anti-HBc (Moderate - (10-20 mg) or high (>20 mg) dose prednisone daily for > 4 weeks
Give examples of moderate risk patients and the type of immunosuppressant therapy that is considered in the moderate risk group?1) +HBsAG / +anti-HBc OR -HBsAG/+anti-HBc (Tumor necrosis factor alpha inhibitors (etanercept {Enbrel}) 2) +HBsAG / +anti-HBc (low dose-prednisone (<10 mg) daily for > 4 weeks 3) -HBsAG/+anti-HBc (moderate (10-20 mg) or high (>20 mg) dose prednisone daily for > 4 weeks
Give examples of low risk patients and the type of immunosuppressant therapy that is considered in the low risk group?1) +HBsAG/+anti-HBc OR -HBsAG/+anti-HBc (Traditional immunosuppressants (Methotrexate) 2)+HBsAG / +anti-HBc OR -HBsAG / +anti-HBC (intraarticular steroids) 3) +HBsAG / +anti-HBc OR -HBsAG / +anti-HBc (any dose of corticosteroids for < 1 week) 4) -HBsAG / +anti-HBc (low dose prednisone (<10 mg) daily for > 4 weeks
What does +HBsAg denote?chronic infection
What does -HBsAg/ +anti-HBc denote?previous exposure
Most organizations (CDC) recommend testing all patients prior to initiation of ______ therapy?immunosuppressive
The American Society of Clinical Oncology (ASCO) recommends testing using a ______ based approach?risk
Prophylaxis with ______ has been shown to decrease the risk of reactivation?antivirals
While there is much experience using lamivudine (Epivir) for prophylaxis, most organizations recommend against its use as a first-line agent, why?because of the significant risk of resistance when used > 1 year
Some experts suggest the use of what two prophlaxis medications?1) tenofovir (Viread) OR 2) entecavir (Baraclude)
*** SUMMARY = Hepatitis B virus reactivation during or after ______ therapy can result in significant morbidity and mortality?immunosuppressive
*** SUMMARY = The risk of reactivation depends on the individual's?1) serological markers 2) type and duration of immunosuppression
*** SUMMARY = What can decrease the risk of reactivation?antiviral prophylaxis
*** SUMMARY = Prophylaxis should continue ___ to ___ months following discontinuation of immunosuppressive therapy?6; 12
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