8. Viral Hepatitis Flashcards
What is the route of transmission of Hepatitis A?
fecal-oral
What is the route of transmission of Hepatitis B?
percutaneous/permucosal
What is the route of transmission of Hepatitis C?
percutaneous/permucosal
Which hepatitis causes chronic infections?
B and C
Which hepatitis is there vaccinations for?
A and B
What are HAV risk factors?
- personal contact
- contaminated food or water
- blood exposure (rare)
What are the clinical presentations of preicteric HAV?
flu-like symptoms, anorexia, NV, RU quadrant pain
What are the clinical presentations of icteric HAV?
- increased LFTs, T. bilirubin
- dark urine
- light grey stools
- worsening systemic symptoms
- pruritus
- jaundice
Fulminant liver failure is very common in HAV. (T/F)
False, fulminant failure is rare in HAV
HAV is almost always a self-limiting disease. (T/F)
True
Nearly all cases of HAV resolve in __ months.
6
HAV Ig_ is positive at onset.
M
HAV Ig_ is positive after 3-12 months.
G
What is the mainstay of treatment for HAV?
symptomatic relief and supportive care
How is HAV transmission prevented?
- hand washing
- improve water source handling
- no raw foods in endemic areas
- vaccines and immunoglobulins
Havrix and Vaqta are live vaccines. (T/F)
False, inactivated
How many doses are HAV vaccines divided into and how are they administered?
2
IM
The CDC recommends HAV vaccine for whom?
- Children at age 1 (since 2006)
- travelers to endemic areas
- MSM
- drug users
- occupational risk
- persons with clotting factor disorders
- chronic liver disease
HAV immunoglobulin is __-__% effective if administered within __ days of exposure.
80-90%
14 days
CDC recommends HAV immunoglobulin for whom?
- household contacts of infected persons
- child care center staff and attendees in outbreak
- institutional outbreaks
- common source exposure (food prepped by infected handler)
What are HBV risk factors?
- sexual activity
- IV drug abuse
- perinatal transfer from mother to child
- healthcare workers
- household contacts
What body fluids have high HBV concentrations?
blood
serum
wound exudates
What body fluids have moderate HBV concentrations?
semen
vaginal fluid
saliva
What body fluids have low/undetectable HBV concentrations?
urine
feces
sweat/tears
breast milk
HIV is 100x more infectious than HBV. (T/F)
False. HBV is 100x more infectious than HIV
What triggers the body’s immune response against HBV?
damage to hepatocytes
What immune cells kill infected hepatocytes?
cytolytic T-cells
What causes fulminant liver failure in HBV?
T-cell response (killing infected hepatocytes)
HAV is the most common cause of fulminant liver failure. (T/F)
False. HBV is the most common cause of fulminant liver failure.
> 95% of adults with acute HBV recover completely without sequelae. (T/F)
True
At what age of infection is the risk of chronic HBV development greatest?
young age
What are the physical findings in HBV?
- fatigue/malaise
- jaundice/scleral icterus
- ascites
- spider angioma
- asterixis (liver flaps)
- severe liver failure
What are some symptoms of fulminant hepatitis (severe liver failure)?
encephalophathy
coagulopathy
HBV immunoglobulin (HBIG) can be administered within __ hours to prevent infection.
48
Who should receive the HBV vaccine?
- all infants born in US after 1991
- healthcare workers
- End-stage kidney disease
- immunocompromised
- high risk behaviors (MSM, multiple sex partners, IV drug use)
What patients should be considered for HBV treatment?
- HBsAg + for > 6 months
- persistant elevation in LFTs
- evidence of viral replication (HBV DNA > 20k)
- signs of chronic hepatitis from liver biopsy
What is seroconversion?
The point at which HBV antibodies (HBeAg) become detectable.
In a patient who is HBeAg+ what are the treatment options and durations?
- PEG IFN-alpha: 48 weeks
- Nucleoside(tide) analogs: 12 months + at least 6 months after seroconversion
In a patient who is HBeAg- what are the treatment options and durations?
- PEG IFN-alpha: 12 months
- Nucleoside(tide) analogs: > 12 months (often indefinite)
What is PEG IFN-alpha?
Pegylated INF-alpha (Pegasys)
What are the generic names of nucleoside(tide) analogs (antivirals) for HBV?
- Adefovir
- Entecavir
- Lamivudine
- Telbivudine
- Tenofovir
What agent(s) are first line in HBV treatment?
entecavir and tenofovir
Which agents have (somewhat) linked resistance?
entecavir and lamivudine
What are ADRs of tenofovir?
renal insufficiency (Fanconi syndrome)
Tenofovir is cross resistant with entecavir. (T/F)
False. tenofovir is cross resistant with adefovir
What are ADRs with Lamivudine?
headache, NV, pancreatitis, peripheral neuropathy
What antivirals are good to use in combination in cases of resistance?
adefovir and lamivudine
How does interferon treat HBV?
induce host antiviral gene expression to
inhibit virus replication, protein synthesis, and
assembly along with enhancing immune
response
IFNs are ideal in patients with decompensated cirrhosis. (T/F)
False, not indicated for patients with decompensated cirrhosis
What are HCV risk factors?
- IV drug use
- hemodialysis
- accidental injuries (needles)
- sexual or household exposure
- multiple sex partners
- perinatal from mother to child
- tattoos (especially nonprofessional)
What is the most common HCV genotype in the US?
1
What are 3 treatment options for G1 HCV (cirrhotic and non-cirrhotic)?
- Sofosbuvir/ ledipasvir (Harvoni)
- Sofosbuvir/ velpatasvir (Epclusa)
- Elbasvir/ grasoprevir (Zepatier)
Which agent should be used with caution when used with gastric acid-reducing agents?
sofosbuvir containing agents
What are 3 treatment options for G1 HCV (cirrhotic ONLY)?
- Ombitasvir + paritarevir + ritonavir + dasabuvir
(Viekira Pak) - Daclatasvir (Daklinza) + Sofosbuvir (Sovaldi)
- Simeprevir (Olysio) + Sofosbuvir (Sovaldi)
What are the treatment options for G2 HCV?
Sofosbuvir/ Velpatasvir
Declatasvir + Sofosbuvir
What are the treatment options for G3 HCV?
Sofosbuvir/ Velpatasvir
Declatasvir + Sofosbuvir (12 weeks non-cirrhotic, 24 weeks +/- ribavirin if cirrhotic)
What is the dosing recommendation for severe renal dysfunction or ESRD for Sofosbuvir?
None, should not be used in ESRD or severe renal dysfunction ( CrCl < 30 mL/min)
Which HCV agents are negatively affected by acid-reducing agents?
Ledipasvir
Velpatasvir
What is the “recipe” of Zepatier?
Elbasvir + grazoprevir
NS5A inhibitor + NS3/4A protease inhibitor
RAV testing for GT_ is required for ______ (drug).
GT1a
Zepatier
What is the MOA of Simeprevir?
NS3/4A protease inhibitor
What is decompensated cirrhosis?
When the body is no longer compensating for significant liver damage and decreased liver function.
You may use monotherapy in HBV treatment. (T/F)
True
You may use monotherapy in HCV treatment. (T/F)
False - never use monotherapy
Hepatitis A is transmitted by
a. blood transmission
b. sexual transmission
c. fecal-oral transmission
d. airbourne transmission
c. fecal-oral transmission
True or false: Hepatitis B is 100x more infectious than HIV.
True
Which of the following typically puts a patient at greater risk of chronic HBV infection and HCC?
a. being a current smoker
b. being infected in another country outside the US
c. being overweight
d. younger age at the time of infection
d. younger age at the time of infection
Which of the following patient populations is considered the highest priority for HCV treatment?
a. persons on long-term hemodialysis
b. pregnant women
c. people with advanced fibrosis or cirrhosis
d. debilitating fatigue
c. people with advanced fibrosis or cirrhosis
Which of the following is a medication used to treat HCV based on current guidelines?
a. Entecavir
b. Ledipasvir/sofosbuvir
c. Interferon
d. Lamivudine
b. Ledipasvir/sofosbuvir
