Things to add to HBV article, hepadnavirus, components: Virology of B: DNA virus, incorporates into nucleus, cccDNA forms template for - strand of DNA (2 ways to form cccDNA)

Chronic B AASLD guidelines 6/12 waiting period **

• Hyperendemic areas
• MSM
• IVDU
• Close contacts of affected
• Pregnancy
• Dialysis patients
• HIV +

1. In ascertaining cirrhosis in patients in whom treatment is being considered (i.e. ALT > 1.5-2x ULN, DNA +, irrespective of eAg status) with interferon and ? of cirrhosis comes up (high AST:ALT, low plt, low plt:AST ratio)
2. In patients with fluctuations of ALT on therapy
3. In making a determination on whether to treat high risk patients (Asian males, those with family Hx of HCC, very high DNA)

• PAN
• Papular acrodermatitis of childhood
• Neuropathy (mononeuritis multiplex)
• Membranous vs. membranoproliferative GN
• Serum sickness (4/12)

• Lamivudine Rx in pregnancy (? data) -> begin Tx at end
• Interferon contraindicated in pregnancy
• Vaccinate child, and give HBIG single dose (ref)

When to give Lam vs. interferon to prevent activation? Evidence (good evidence for PEG and C)

• Cirrhosis
• BM suppression
• Solid organ transplant other than liver
• Severe hyper or hypothyroidism
• Pregnancy
• Uncontrolled depression

AFP AND US for high risk: In general:

• Cirrhotics with B
• Active hepatitis (be it biochemical or histological)
• Carriers: Asian males > 40, Asian females > 50, Africans > 20, FHx HCC, High DNA, pronged activity (from Morris Sherman's AASLD guidelines Hepatology Nov 2005)

• Interferon-2-alfa, 5 MU d or 10 q / MWF, SE: N/V flu-like/malaise itchiness/hair loss depression, suicidality hyper/hypothyroidism cytopenias
• Duration=24/52 (eAg+) 1 yr (eAg-)
• Efficacy (defined by eAg->eAb OR eAg- -> absence of DNA)
  • eAg + 33% (durable 80%)
  • eAg - 60-70% BUT NOT DURABLE (20%)

• NRTI (cytidine)
• HIV -: 100 q d HIV +: 150 bid (ensure that HAART is given to prevent mutation)
• Rx duration 52 weeks all comers
• Efficacy
  • (eAg + 17-32% poorly durable 50% - 80%)
  • (eAg - 60-70%, durable <10%)
• SE = rare, well tolerated, N/V, rare pancreatitits, mutants incl. YMDD
• Mention that it can be used in cirrhotics
• resistance 1 yr = 20% / 5 yr = 70% !! vs. adefovir ~ 2% @ 5 yrs.
• treat for 6/12 AFTER seroconversion, no date for eAg -

NRTI (AMP) Can be added to YMDD Rx 10 daily S/E = nephropathy

• Rx 1 yr
• 24%/51%
• Not durable
• Decompensated cirrhotics - risk of HRS 2o nephrotoxicity!
• rtN236T is Downstream to YMDD motif