215.3 🩺 內科專科考前版

215.3.0.1 1⃣ Bulevirtide Clinical Use

  • 2 mg SC daily
  • Treatment duration not clearly defined (continuing investigation)
  • Cost / access barrier
  • Combination with peg-IFN being studied for higher response
  • Drug interactions: OATP1B1/3 inhibition affects atorvastatin, rosuvastatin, others
  • Monitor ALT + HDV RNA + HBsAg

215.3.0.2 2⃣ HEV Pregnancy Travel Counseling

  • Pregnant women avoid travel to genotype 1/2 endemic regions
  • Boiled / bottled water only
  • Avoid raw/undercooked meats
  • Hepatitis A vaccination + sanitation precautions
  • If HEV in pregnancy: immediate hospitalization + maternal-fetal medicine

215.3.0.3 3⃣ Chronic HEV in Solid Organ Transplant

  • Kidney + liver + heart transplant most common
  • Test for HEV RNA in elevated LFTs unexplained
  • Reduce calcineurin inhibitor (tacrolimus, cyclosporine) dose
  • Ribavirin 200-1000 mg/day × 3-12 mo
  • 80% SVR
  • Some require longer course or retreatment
  • Anemia + teratogenicity counseling

215.3.0.4 4⃣ HEV + GBS

  • HEV common cause of GBS in Europe
  • Test acute GBS for HEV serology + RNA
  • Treatment: standard GBS (IVIG, plasmapheresis) + ribavirin if active HEV
  • Outcome usually good

215.3.0.5 5⃣ HEV in Italy + France

  • Genotype 3 endemic
  • Undercooked pork sausage (rich in liver tissue) implicated
  • “Mortadella, salame” outbreaks reported
  • Public Health awareness

215.3.0.6 6⃣ HDV Screening in HBV Patients

  • All chronic HBV patients: anti-HDV antibody at least once
  • Risk factors for HDV: from endemic region, IDU, MSM
  • HDV RNA if anti-HDV+
  • Treatment options if chronic HDV confirmed

215.3.0.7 7⃣ HDV in Mongolia

  • Highest national prevalence globally (~ 15-30% of HBV-infected)
  • Significant public health priority
  • Local treatment programs

215.3.0.8 8⃣ 健保 / Taiwan

  • 通報 HBV / HDV / HEV
  • 健保 ribavirin for HEV chronic indication
  • Bulevirtide (Hepcludex) — not yet 健保 approved Taiwan (2024); 自費 / compassionate use
  • HEV genotype 4 detected sporadic Taiwan

215.3.0.9 9⃣ Liver Transplant + HEV / HDV

  • HEV: chronic recurrence in some recipients (immunosuppression); ribavirin
  • HDV: HBV+HDV recurrence prevented with HBIG + nucleoside analog
  • Outcomes similar to HBV alone after liver transplant + appropriate prophylaxis

215.3.0.10 10. WHO Targets

  • 2030 elimination of viral hepatitis (combined A-E)
  • HBV: birth-dose vaccine + treatment
  • HCV: mass treatment + DAAs
  • HDV: bulevirtide rollout
  • HEV: vaccine deployment + sanitation
  • HAV: vaccination + sanitation