B5.030 Viral Hepatitis Large Group

Question 1

tenofovir disoproxil mechanism

Answer 1

nucleotide analog of adenosine monophosphate and a reverse transcriptase inhibitor

Question 2

tenofovir uses

Answer 2

inhibits viral reverse transcriptase of HIV and HBV

limited inhibition of human enzymes

Question 3

lamivudine 3TC) mechanism

Answer 3

analogue of cytidine
antiretroviral medication
can inhibit both types of HIV reverse transcriptase and the reverse transcriptase of HBV
phosphorylated to active metabolites that compete for incorporation into viral DNA
use competitive inhibition and act as a chain terminator of DNA synthesis

Question 4

lamivudine uses

Answer 4

used to prevent and treat HIV and chronic HBV (when other options are not possible)

Question 5

downside to lamivudine

Answer 5

rapid resistance develops

30% after 2 years, 70% at 5 years

Question 6

entecavir mechanism

Answer 6

deoxyguanosine analogue that inhibits reverse transcription, DNA replication and transcription in the viral replication process

Question 7

adefovir dipivoxil mechanism

Answer 7

blocks reverse transcriptase

resistance doesn’t develop as quickly as with lamivudine

Question 8

telbivudine mechanism

Answer 8

synthetic thymidine B-L-nucleoside analogue
intracellularly phosphorylated to the active triphosphate form, which competes with the natural substrate to inhibit HBV reverse transcriptase
reduces DNA replication by chain termination

Question 9

combined HIV/HBV agents

Answer 9

tenofovir

lamivudine

Question 10

chemical HBV agents

Answer 10

entecavir
adefovir dipivoxil
telbivudine

Question 11

what is the function of IFN-a in HBV treatment

Answer 11

predominantly immunomodulatory effects

cytokine also exerts a limited direct antiviral effect

Question 12

mechanism of IFN-a

Answer 12

binds to cellular receptor and activates secondary messengers, resulting in the production of multiple proteins that are important for the defense of the cell against viruses

Question 13

immunomodulatory effects of IFN-a

Answer 13

enhancement of antigen presentation to immune system
activation of NK cells and other immune cells
production of cytokines

Question 14

antiviral effects of IFN-a

Answer 14

degradation of viral mRNA
inhibition of viral protein synthesis
prevention of infection of cells

Question 15

primary test for hep B screening

Answer 15

HBsAg

hep B viral load used for quantitative measure

Question 16

what can be detected during acute hep B infections

Answer 16

anti-HBc IgM

Question 17

what does anti-HBs in serum signify

Answer 17

protective antibody in those with prior infection or those who have been vaccinated
anti-HBc = had infection before

Question 18

serology that characterizes chronic hep B

Answer 18

positive HBsAg

detectable HBV DNA levels for more than 6 months

Question 19

why does hep D require hep B?

Answer 19

HBV provides HBsAg which is incorporated into the HDV membrane allowing the virus to infect hepatocytes

Question 20

coinfection

Answer 20

susceptible anti-HBs-negative individual is infected with HDV and HBV
mostly leads to eradication of both viruses

Question 21

superinfection

Answer 21

chronic HBV carrier is infected with HDV
most evolve to chronic HDV infection and hepatitis
chronic HDV infection worsens the preexisting HBV related liver damage

Question 22

characterize HDV associated liver damage

Answer 22

necroinflammation
relentless deposition of collagen
cirrhosis and HCC possible

Question 23

histo cells associated with HBV

Answer 23

ground glass hepatocytes

contain surface antigens in the ER

Question 24

describe ground glass hepatocytes

Answer 24

abundance of ER among which viral particles of surface antigens accumulate
overloaded ER makes cytoplasm foggy/glassy

Question 25

effect of alcohol on HCV

Answer 25

alcohol puts HCV patients at risk for more severe liver injury
alcohol promotes disease progression to cirrhosis and increases risk for liver cancer
moderate drinking may have some of these effects as well, but results are inconclusive

Question 26

discuss HCV disease progression

Answer 26

15% resolve after acute infection
85% have chronic infection
of those with chronic infection, 20% get cirrhosis after 20ish years
cirrhosis can lead to ESLD (6%), HCC (4%), or LT/death (3-4%)

Question 27

what factors can speed the progression of chronic HCV

Answer 27

HIV
HBV
alcohol
fatty liver

Question 28

3 main pathological scoring systems used to assess histo disease grade in chronic hepatitis

Answer 28

Knodell (4 stages)
METAVIR (5 stages)
Ishack (6 stages)

Question 29

common treatment for HCV

Answer 29

sofosbuvir

ledipsavir

Question 30

ledipasvir mechanism

Answer 30

potent inhibitor of HCV NS5A

viral phosphoprotein that plays an important role in viral replication, assembly, and secretion

Question 31

sofosbuvir mechanism

Answer 31

nucleotide analog inhibitor of HCV NS5B polymerase, the key enzyme mediating HCV RNA replication
mimics uridine nucleotide and acts as a chain terminator