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Chapter 24. Viral Hepatitis

Student Questions

A 37-year-old Hispanic woman presents with complaints of "yellow eyes." She denies any recent travel. She admits to attending a birthday party at a Japanese Sushi restaurant 10 days ago. Her primary care physician ordered laboratory tests; the ALT level is mildly elevated and hepatitis serologies are anti-HAV IgM (+), anti-HAV IgG (–), HBsAg (–), anti-HBc IgG (–), anti-HBc IgM (–), and anti-HCV (–). Which vaccine(s) should be recommended?

A. Hepatitis A and immune globulin

B. Hepatitis B and immune globulin

C. Hepatitis A vaccine

D. Immune globulin

Answer: C

Option A: Incorrect. Patients who are less than 40 years old only need the hepatitis A vaccine to prevent clinical symptoms of hepatitis. Immune globulin is recommended for persons older than age 40, less than 12 months old, or who are immunocompromised.

Option B: Incorrect. The patient does not have hepatitis B and will need the HBV vaccine. Immune globulin is not needed because it is only recommended if the patient does have HBV and the HBV infection was acquired within 14 days of exposure.

Option C: Correct. Patients who are not immunocompromised and less than 40 years old may receive only the HAV vaccine to reduce the risk of developing clinical hepatitis symptoms.

Option D: Incorrect. Patients who are immunocompromised or less than 12 months or more than 40 years old would only receive immune globulin.

A 47-year-old white man has HBeAg-positive chronic hepatitis B. His risk factors include using intravenous drugs at the age of 18 and a jailhouse tattoo 25 years ago. His past medical history is significant for hypertension and severe depression. His renal function is normal, and ALT levels are four times the upper limits of normal. Which one of the following is the best treatment option for his hepatitis B?

A. Entecavir

B. Sofosbuvir

C. Pegylated interferon

D. Adefovir dipivoxil

Answer: A

Option A: Correct. The first-line regimen for treatment of HBV is entecavir (the other recommended oral agent is tenofovir).

Option B: Incorrect. Sofosbuvir is indicated for treatment of HCV.

Option C: Incorrect. This patient has severe depression; pegylated interferon is not recommended for patients with severe psychiatric conditions.

Option D: Incorrect. Adefovir dipivoxil is a treatment for HBV but is no longer recommended as first-line therapy due to an increased risk of ...

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