Skip to Main Content

CHAPTER SUMMARY FROM THE PHARMACOTHERAPY HANDBOOK

For the Chapter in the Schwinghammer, Handbook (not Wells Handbook anymore) please go to Chapter 25, Hepatitis, Viral.

KEY CONCEPTS

KEY CONCEPTS

  • imageHepatitis A virus (HAV) is transmitted via the fecal–oral route, most often from ingestion of contaminated food or water, or through contact with an infected person.

  • imageHAV causes an acute, self-limiting illness and does not lead to chronic infection. There are three stages of infection: incubation, acute hepatitis, and convalescence. Rarely, the infection progresses to liver failure.

  • imageHAV is vaccine preventable. There is no pharmacological treatment specifically for HAV as treatment consists of supportive care.

  • imageHepatitis B virus (HBV) causes both acute and chronic infection. Chronic infections are responsible for high rates of liver disease, liver cancer, and death.

  • imageVaccination can prevent HBV and is the most effective strategy in preventing complications of HBV infections. Prevention of HBV infections focuses on immunization of all children and at-risk adults.

  • imageThe purpose of anti-HBV drug therapy is for viral suppression and immune control and to prevent progression of liver disease and the complications associated with HBV infections.

  • imageInitial therapy of chronic HBV is with tenofovir or entecavir because these agents have a high barrier to resistance. Therapy is often long term.

  • imagePatients undergoing immunosuppressive therapy or chemotherapy should be screened for HBV infections and may require HBV therapy to reduce the risks of reactivating their HBV and developing fulminant liver failure.

  • imageThe hepatitis C virus (HCV) is an insidious, blood-borne infection. Increased screening of all patients born between 1945 and 1965 was implemented to help identify the many people unaware of their infection.

  • imageHepatitis C infections can cause significant morbidity (including extrahepatic manifestations) and mortality. Patients with chronic hepatitis C are at risk for end-stage liver disease, cirrhosis, liver transplant, and death as a result of their infection.

  • imageThe goal of anti-hepatitis C virus (HCV) drug treatment is cure. Drug therapy with direct-acting antivirals (DAAs) is highly effective and well tolerated.

PATIENT CARE PROCESS

Patient Care Process for Hepatitis C

image

Collect

  • Patient characteristics (eg, age, sex, weight, vital signs, etc.)

  • Patient history (past medical, family, social) and medical record summary including surgical operations (site, date, procedure) and abdominal imaging findings

  • Thorough medication history (include prescription, nonprescription medications, and other substances) and drug allergies and intolerances. Previous HCV therapy, if applicable.

  • Laboratory results for chronic HCV infection including HCV genotype and viral load (RNA)

  • Laboratory results for other viral infections impacting HCV treatment (HBV core antibody, HBV surface antigen, HBV surface antibody, HAV total or IgG antibody, HIV status)

Assess

  • Determine severity of underlying liver disease based on laboratory tests, clinical calculators, imaging, and clinical history

  • If the patient has cirrhosis, assess the level of liver dysfunction using the Child-Pugh Score to determine options for HCV therapy

  • Estimate creatinine clearance to identify which HCV therapies may be used

  • Review insurance ...

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.