Exam 3: Hepatitis

Question 1

Hepatitis common symptoms/signs

Answer 1

n/v/d
abdominal pain
fever
jaundice
elevated AST/ALT

Question 2

Hep A and E family, envelope status, transmission

Answer 2

RNA pico (A), RNA hepe (E) - similar to calici
Naked, acid stable
Fecal oral
A: shellfish, travelers, day care
E: waterborne

Question 3

Hep A vaccine, passive immunization, dx on serum

Answer 3

Killed vaccine
Passive vaccination with preformed abs
Dx = HAV IgM

Question 4

Hep A on liver biopsy

Answer 4

Hepatocyte swelling
monocyte infection
Councilman bodies (extracyto, eosinophilic)

Question 5

Hep E highlight reel
Reservoir
3 E’s of Hep E

Answer 5

Fulminant hepatitis in 3rd trimester pregnant women
No FDA approved vaccine
Res: pigs
Expectant, Enteric, Epidemic

Question 6

Hep B family, envelop status, transmission

Answer 6

DNA hepadnavirus
Enveloped
Blood/Baby (sex)/Birth

Question 7

Hep B acuity and vaccine

Answer 7

Acute infection, minority (10%) go chronic

Vaccine: one serotype, Anti-HBs only in vaccinated

Question 8

Hep B vertical transmission

Answer 8

Cycled between mother/daughter/mother/daughter

Active and passive immunization of newborn to stop cycle

Question 9

Hep B replication
Genome size
Unique features

Answer 9

Small genome, very efficient
Overlapping ORFs (making gene one way makes something else the other way)
Partial single partial double DNA
Reverse transcriptase (on egression rather than entry)

Question 10

Age differences in Hep B infection

Answer 10

Young: don’t get sick, don’t clear -> chronic
Old: get sick, clear -> less chronic

Question 11

Treatment/serum monitoring:
Acute infection
Neonate

Answer 11

Immune response with fall of HBsAg and rise of Anti-HBs is acute and will probably clear
High HBsAg with no Anti-HBs -> going chronic
No acute treatment - self limited

Neonate: active and passive immunity with positive mom

Question 12

Treatment for chronic HBV

Answer 12

Tenofovir (RT inhibitor)

Treatment depends on viral load

Question 13

HDV infection, genome, replication

Answer 13

Requires HBV coinfection
Circular ssRNA (-) with delta antigen (infectious part)
Replication via host Pol2 (rolling circle)

Question 14

HCV treatment history

Answer 14

93: IFN, ribavirin
00: peg-IFN, ribavirin
11: peg-IFN, ribavirin, protease inhibitors (STEP1)
15: direct acting anti-virals

Question 15

HCV genome

Answer 15

Structural genes: C, E1, E2

Replication/non-structural: NS3, NS5a etc - target for drug

Question 16

HCV Direct Acting Antivirals (gene and drugs)

Answer 16

NS3 protease: telaprevir, boceprevir, paritaprevir (PREVIR)
NS5A: ledipasvir, velpatasvir, ombitasvir (ASVIR)
NS5B: sofosbuvir, dasabuvir (BUVIR)

Protease inhibitors now obsolete
Work for ALL GENOTYPES (so rad)

Question 17

Hep C vaccine

Answer 17

Yeah, there’s not one

Too much antigenic varation