Hepatitis

Question 1

Hepatitis A

Answer 1

RNA - Picornavirus

Fecal oral transmission

Question 2

Prevention for Hep A

Answer 2

Vaccine

Immunoglobulin pre- and post- exposure (within 14 days)

Question 3

Hepatitis E

Answer 3

RNA - Hepevirus

Fecal oral transmission

Question 4

IgM

Answer 4

Acute exposure <6 months

Question 5

IgG

Answer 5

Previous exposure >6 months, now immune

Question 6

Hepatitis B

Answer 6

DNA - Hepadnavirus

Parenteral, sexual, maternal-fetal

Question 7

Hepatits C

Answer 7

RNA - Flavivirus

Primary blood

Question 8

Hepatitis D

Answer 8

RNA - Delta virus

Parenteral, sexual, maternal-fetal

Question 9

Anti-HAV (IgM)

Answer 9

IgM antibody to HAV; best test to detect active hep A

Question 10

Anti-HAV (IgG)

Answer 10

IgG antibody indicates prior HAV infection and/or prior vaccination; protects from reinfection

Question 11

HBsAg

Answer 11

Antigen found on surface of HBV; indicates hep B infection

Question 12

Anti-HBs

Answer 12

Antibody to HBsAg; indications immunity to Hep B

Question 13

HBcAg

Answer 13

Antigen associated with core of HBV

Question 14

Anti-HBc

Answer 14

Antibody to HBcAg; IgM - acute/recent infection; IgG = prior exposure to chronic infection
Positive during window period

Question 15

HBeAg

Answer 15

Indicates active viral replication and high transmissibility

Question 16

Anti-HBe

Answer 16

Antibody to HBeAg; indicates low transmissibility

Question 17

What is seroconversion?

Answer 17

Ability to clear Hep B – loss of HBeAg and development of HBeAb

Question 18

How do newborns react differently than adults to Hep B?

Answer 18

Newborns develop the chronic disease

Adults have a developed immune system and are able to clear the disease

Question 19

What is done in a case of Hep B exposure in an unvaccinated patient?

Answer 19

Give Hep B immune globulin within 24 hours (preferable) or within a week
Second dose of HBIG 1 month later

OR

Hep B vaccin (within 24 hours - or within 1 week)
Second dose 1 month after first
Third dose 6 months after first

Question 20

What is done in the case of Hep B surface antigen positive mothers?

Answer 20

Give newborn both HBIG and vaccine

Question 21

Can Hep B lead to HCC?

Answer 21

Yes! Even without going through cirrhosis

Question 22

What are some treatments for Hep B?

Answer 22

Interferons - released by host cells when infected with viruses, activated immune system [Interferon alfa-2b, PEG-interferon alfa-2a]
Antivirals (nucleoside/nucleotide analogues) - block reverse transcriptase that is necessary for HBV replication [Entecavir, Tenofovir]

Question 23

What is the success of HBV therapy?

Answer 23

Eliminate or suppress HBV replication = 30% after therapy discontinuation
ALT normalization = 30%
Loss of HBeAg, development of HBeAb (seroconversion) = 30%
Loss of HBsAg = 5-7%

Question 24

What is the difference between an HBV-HDV confection and a superinfection?

Answer 24

Coinfection = get them at the same time; severe
Superinfection = have Hep B first, then get Hep D; leads to chronicity

Question 25

What are the nonstructural proteins of HCV for?

Answer 25

viral replication – these are the targets of therapeutics called Direct acting antivirals (DAA)

Question 26

Who exhibits Hep C antibody?

Answer 26

All exposures make Hep C antibody and remains present in all patients including those who spontaneously clear the virus or undergo successful treatment
Hep C RNA is only present in those who are viremic