GASTROENTEROLOGY ARTICLE OF THE WEEK
November 6, 2008
Dienstag JL. Hepatitis
B Infection. N Engl J Med
2008;359:1486-500
1. Patients with HBeAg-negative active disease
are characterized by
a.
Extremely high levels of HBV-DNA
b.
The presence of a
precore or core promoter gene mutation
c.
Persistently
elevated levels of ALT
d.
The ability to
obtain a long-lasting response off therapy after becoming HBV-DNA negative.
2. Adefovir
a. Is not cross-resistant with lamivudine or
telbivudine
b. Is the weakest antiviral, with the highest
risk for primary non-response
c. Has an unacceptably high resistance rate in
the first year
d. Is the least likely agent to induce HBeAG
seroconversion in the first year
3. Which of the
following statements places oral agents in order of likelihood of resistance
(from more likely to develop resistance to less likely)
a. telbivudine à lamivudine à entecavir à adefovir à tenofovir
b. lamivudine à telbivudine à entecavir à adefovir à tenofovir
c. lamivudine à telbivudine à adefovir à entecavir à tenofovir
d.
lamivudine à telbivudine à entecavir à adefovir à tenofovir
True or False
4. Covalently closed circular DNA (cccDNA)
becomes established in the hepatocyte nuclei and makes this infection difficult
to eradicate
5. Treatment with interferon for one year is
more likely to induce HBeAG seroconversion compared to one year of oral
therapy.
6. Among the available oral agents, entecavir and
tenofovir have the lowest resistance rates.
7. After achieving HBeAG seroconversion on
treatment, discontinuing nucleoside analog therapy 6-12 months later results in
80% durable response.
8. Antiviral therapy for hepatitis B is
contraindicated in patients with decompensated liver disease.
9. Telbivudine use has been associated with a
higher incidence of creatine kinase elevation compared to other nuclesoides
10. During the first decades of immune tolerance
in perinatally-acquired HBV, ongoing liver damage is the rule.
11. People with viral loads below 1,000 IU and
normal ALT levels are considered to be inactive carriers.
12. Combination therapy with two agents is more
efficacious than single agent in achieving a durable response
13. Patients with HIV/HBV co-infection should not
receive single-agent therapy for HBV