Drs. Rebecca Grandy and Shuchin Shukla of MAHEC Family Medicine presented a talk on “Hep C and HIV PrEP: An Overview“ at the Governor’s Institute’s recent Addiction Medicine 2020 conference. There was not sufficient time for all of the questions so we asked them to answer 2 more: one about reactivation of Hep B with Hep C treatment and the other about the pneumococcal vaccine.
Q: I thought that the major risk of stopping Hep C treatment was Hep B recrudescence. Can you comment?
A: When someone is infected with Hep B and Hep C, the Hep C virus usually dominates. Once Hep C is suppressed or cleared by DAAs (direct acting antivirals), the Hep B virus has a chance to re-emerge. The exact mechanism of all this is unknown. Here is a nice article. https://www.gastrojournal.org/article/S0016-5085(18)30161-6/pdf. The biggest teaching point is the need to screen for Hep B prior to treatment.
Q: What is the rationale for pneumococcal vaccine?
A: This is a recommendation by the CDC for patients with liver disease, so we do it for our patients with cirrhosis. Reference: https://www.cdc.gov/vaccines/schedules/hcp/imz/adult.html
Conference attendees can access the Powerpoints and recorded presentations on the eeds.com conference website.
We’ll answer more questions from the virtual Addiction Medicine Conference in upcoming newsletters. Be on the lookout!