Hepatitis

Question 1

Tx for hep C

Answer 1

VIEKIRA PAK

Ombitasvir
Paritaprevir
Ritonavir
Dasabuvir

Question 2

Which Heps are transmitted F-O

Answer 2

HAV

HEV

*these ones do not result in chronic infxn

Question 3

Which Heps are transmitted via Parenteral, sexual, perinatal

blood/body fluids

Answer 3

HBV
HCV
HDV

• percutaneous/ Permucosal
• these ones result in chronic infxn

Question 4

Sx of (all) hepatitis if present (8)

Answer 4

N/V
Abdominal pain
Loss of appetite
Fever
Diarrhea
Light/clay colored stools
Dark urine
Jaundice
High AST+ALT

Asymptomatic> Symptomatic > Fulminant Liver failure > Death

Question 5

Which Heps can result in life long carriers of Hep

Answer 5

HBV
HCV
HDV

*these guys are also at risk for HCC

Question 6

Notes on HAV

Answer 6

Asymptomatic (usually)
Acute
Alone (no carriers)
Acid stable

Question 7

Leading cause of liver transplants

Answer 7

HCV

Question 8

Which has more mortality, HAV or HEV?

Answer 8

HEV 10x more

Question 9

When do symptoms peak for HAV and HEV

Answer 9

HAV: 2-8 weeks

HEV: 5-8 weeks

Question 10

Notes on HBV

Answer 10

Blood
Baby making
- chronic infxn of infant if not vaccinated immediately after birth
Birthing

Question 11

What % of HBV develops into chronic infxn in adults? Infants?

Answer 11

5-10% in adults
- can mount robust response, get sicker, but clear the infxn

90% in infants
- cant mount robust immune response and get chronic infxn
(but dont get as sick)

Question 12

What does HBeAg and Anti-HBe indicate?

Answer 12

HBeAg: A second, different antigenic determinant in the HBV core. Indicates active viral replication and high transmissibility.

• First to occur
• shows up early in infxn, indication of infectivity

Anti-HBe: Antibody to HBeAg

• indicates low transmissibility
• Shows up second

Question 13

AST+ ALT lvls in viral hepatitis vs alcoholic hepatitis

Answer 13

Viral: ALT > AST

Alcoholic hep: AST > ALT

Question 14

What does HBsAG indicate?

What about Anti-HBs?

Answer 14

HBsAg: antigen found on surface of HBV; indicates Hep B infxn
- first to appear

Anti-HBs: Antibody to HBsAg; indicates immunity to Hep B

• occurs second
• no longer has acute/chronic infxn

Question 15

HBV treatment for:
Acute infxn (nl adult)
Neonate (of HBsAG+ mom)
Chronic infxn:

Answer 15

Acute infxn (nl adult)
- no treatment req.

Neonate (of HBsAG+ mom)
- Vaccinate!

Chronic infxn:

• Lamivudine: RT inhibitor
• Adefovir: dATP analogue
• Entecavir: guanine analogue
• Tenofovir

Question 16

Which Hep virus is a defective virus that requires coinfection with HBV?

Answer 16

HDV

- particles packaged with stolen HBV S antigen

Question 17

When do you get HDV superinfxn?

Coinfxn?

Answer 17

Superinfxn (worst one):
HDV AFTER HBV - short incubation
- adds HDV on top of infxn: burst of new dmg

Coinfection:
HDV with HBV - long incubation

Question 18

Starting when did we start screening HCV?

Answer 18

1990

discovered 1989

Question 19

tx for HCV

Answer 19

All orals Direct acting antivirals (DAAs)

• NS3-4A protease
• NS5A inhibitors
• NS5B inhibitors

*Replaced the old:
IFN-a, Protease inhibitor, Ribavirin

Question 20

Notes on HCV

Answer 20

Chronic,
CIrrhosis
Carcinoma
Carrier

Question 21

Why isnt there a vaccine for HCV?

Answer 21

Antigenic variability
- lack of proofreading in 3-5 exonuclease activity in virion
(protein structure varies)