Hepatitis

Question 1

How do you treat an acute HBV infection in an adult?

Answer 1

No treatment

Question 2

How do you treat a Neonate of a HBsAg+ mother?

Answer 2

Vaccinate!

Question 3

How do you treat a chronic HBV patient?

Answer 3

• IFN/pegylated IFN (limited efficacy - knock viral load down but won’t clear it)
• Lamivudine (DDNRTI)
• Adefovir - acyclic analogue of dATP
• Entecavir - guanine analogue

Question 4

Does tenofovir clear the HBV?

Answer 4

No, it just knocks the viral load down

Question 5

Which hepatitis requires coinfection with B?

Answer 5

Hepatitis D

Question 6

What is the structure of HDV

Answer 6

Circular ssRNA encoding delta antigen

• Packaged with HBV S antigen (HBVsAg)
• HDV with HBV increases severity of hepatitis

Question 7

Does the vaccine for HBV also cover for HDV?

Answer 7

yes, because it requires coinfection!

Question 8

Is there a DNA component to the delta antigen? Does it need a RNA dependent RNA polymerase?

Answer 8

No DNA component

Requires Pol II, does not encode its own polymerase - fools pol II to take an RNA template instead of a DNA template

Question 9

True or false - when you clear hepB you clear hepD

Answer 9

True

Question 10

If you have chronic HBV and then get an HDV super infection, can you clear HDV?

Answer 10

No, HDV becomes chronic alongside HBV

Question 11

When was HCV discovered?

Answer 11

1989

Question 12

General characteristics of HCV

Answer 12

• Hepacivirus (Flaviviridae)
• Genotypes 1-7, multiple subtypes
• Parenteral transmission
• Does not replicate in mosquito - not arborovirus
• Acute infections are subclinical
• 50-80% of acute infections become chronic infections
• No Vaccine

Question 13

Treatment options for HCV

Answer 13

• IFN and Ribavirin
• Peg-IFN + Rb
• Peg-IFN + Rb + HCV protease inhibitors
• All-oral DAAs (direct acting antivirals) - target NS3-4A protease, NS5A, and NS5B RdRP inhibitors

1 pill a day for 12 wks with DAAs = cure

Question 14

Most common cause of spread of HCV in US

Answer 14

IV drug abuse / Inappropriate use of injection drugs in healthcare settings

Question 15

Replication of HCV

Answer 15

+ strand RNA –> - strand synthesis –> + strand synthesis

Question 16

Mutation rate of HCV

Answer 16

1*10^4 errors per nt (1 error per 10kb)
40 RCs per hepatocyte
10^12 HCV virions per day per person

Question 17

Which genotype is the most common in the US?

Answer 17

Genotype 1

Question 18

How long is the HCV incubation period?

Answer 18

6-7 weeks

Question 19

What is the most common reason for liver transplants in the US?

Answer 19

HCV associated liver failure

Question 20

What was a common (but not good) outcome of treatment with peg-IFN and Ribavirin

Answer 20

ETR - End of Treatment Response

• they looked like it went away for the duration of treatment and then relapsed as soon as they came off of treatment

Question 21

Genetic variation in ___ predicts HCV treatment-induced viral clearance

Answer 21

IL28B (IFN-1) variation

Question 22

Telaprevir and Boceprevir are what class of DAAs

Answer 22

They are NS3/4A Protease inhibitors

Question 23

Patient has elevated liver enzymes in serum and elevated serum bilirubin… what do they have?

Answer 23

Hepatitis

Question 24

Patient has anti-HAV IgM… Dx?

Answer 24

Recent infection

Question 25

Patient has Anti-HAV IgG … Dx?

Answer 25

Past infection or vaccine (lifelong immunity)