HBV - Private Practice Infectious Disease

The following series of questions relates to HBV diagnosis and management.

Which of the following is considered the main indicator of reactivation of previously resolved HBV (HBsAg-, anti-HBc+)?

A. Increase in ALT two times the upper limit of normal

B. Development of detectable HBV DNA

C. Development of HBsAg

D. A and C

E. B and C

None

You are asked to evaluate a patient with a history of Hepatitis B virus who is scheduled to receive Rituximab for Non Hodgkin’s lymphoma (NHL). He arrives with a set of blood work from his oncologist’s office. Results demonstrate HBsAg+ and HBcAb+ with an undetectable HBV DNA.

A. Serial ALT, HBV DNA, and HBsAg every 1-3 months with “on demand” anti-viral prophylaxis as needed

B. Anti-viral prophylaxis during the time he is on rituximab

C. Anti-viral prophylaxis for 6 months after stopping rituximab

D. Anti-viral prophylaxis for 12-18 months after stopping rituximab

None

Another patient with a PMH of Crohn’s Disease that is about to be started on Adalimumab (Humira) arrives to you because her gastroenterologist is concerned about the potential of HBV reactivation given her history of the infection in the 1990’s. Her baseline labs include the following: HBsAg-, HBc Ab+ and undetectable DNA.

A. Serial ALT, HBV DNA, and HBsAg every 1-3 months with “on demand” anti-viral prophylaxis as needed

B. Anti-viral prophylaxis during the time she is on adalimumab

C. Anti-viral prophylaxis for 6-12m after cessation of adalimumab

D. Anti-viral prophylaxis for 12-18m after cessation of adalimumab

E. Either A or C

None

Which of the following anti-viral agents would you recommend for HBV prophylaxis?

A. Entecavir

B. Tenofovir Alafenamide (TAF)

C. Tenfovir Disoproxil Fumarate (TDF)

D. Lamivudine

E. Answers A, B and C

F. All of the above

None

Board Review: HBV

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