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Medicine

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Liver & GIT

Question
9 out of 10
 

Treatment of chronic hepatitis is? (PNQ)



A Lamivudine
B Adefovir

C Entecavir
D All of the above

Ans. D All

Indication of antiviral drug in chronic hepatitis B

1. No treatment is indicated for asymptomatic non replicative hepatitis B carriers (undetectable HbeAg with normal

ALT and HBV DNA<104 copies/mL documented serially over time).

2. Assessment of need for antiviral therapy in Chronichepatis B

3. Antiviral therapy is indicated for patients with active HBV replication.

4. Active HBV replication is best assessed by measuring serum HBe Ag levels and HBV DNA levels.

Patients with chronic hepatitis B (HBsAg – Positive) (Ref. H-18thedi, Pg 2569)

HBe Ag level

HBeAg reactive (positive)

HBeAgNon Reactive (Negative)

HBV DNA

HBV DNA

Levels Low (<105 copies/ml)

Levels High (>105 copies/ml)

Levels High (>105 copies/ml)

Levels Low (<105 copies/ml)

Hbe Ag positive

HBV DNA low

HBe Ag positive

HBV DNA levels high

HBe Ag Negative

HBV DNA levels high

HBe Ag Negative

HBV DNA levels low or undetectable

Such patients are usually asymptomatic clinically and have normal liver enzymes

Assess ALT levels

Diagnosis

HBeAg negative chronic

Hep B

Diagnosis

Inactive carriers of Chronic Hepatitis

Normal

Elevated

Assess ALT levels

Require sequential biochemical virological monitoring

Require sequential biochemical / Virological monitoring

No treatment (current treatment of limited value)

-Consider liver biopsy

- Continue monitoring

Require antiviral treatment

Normal

No treatment (current treatment of limited value)

- Consider liver biopsy

- Continue monitoring

Elevated

Require antiviral treatment

Summary of treatment:Treat a case of chronic hepatitis only If there is increase in DNA copies & raised ALT !!!

Extra Edge: No Antiviral drugs is given in acute viral hepatitis B (Ref. Hari- 18th ed., Pg.-2554)

1. In Acute Hepatitis B, recovery occurs in ~99%; therefore, antiviral therapy is not likely to improve the rate of recovery and is not required.

2. Severe acute hepatitis B is not an indication for anti viral therapy. Only supportive treatment is given.

Chronic Hep B

1. Although progression to cirrhosis is more likely in severe than in mild or moderate chronic hepatitis B, all forms of chronic hepatitis B can be progressive, and progression occurs primarily in patients with active HBV replication.

2. In populations of patients with chronic hepatitis B who are at risk for HCC, the risk is highest for those with continued, high-level HBV replication.

3. Therefore, management of chronic hepatitis B is directed at suppressing the level of virus replication.

Five drugs have been approved for treatment of chronic hepatitis B:

1. Injectable interferon (INF)α;

2. Pegylated interferon [long-acting IFN bound to polyethylene glycol (PEG), known as PEG IFN];

3. Lamivudine

4. Adefovir dipivoxil

5. Entecavir.

Recent Advance: Newer Drugs (Ref. Hari-18th ed., Pg. 2569)

1. Emtricitabine

2. Tenofovir

3. Telbivudine

4. Pradefovir

5. Clevudine

Liver & GIT Flashcard List

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