Hepatitis

Question 1

Positive strand RNA genome with open reading frame encoding for structural and non-structural proteins

Answer 1

Hepatitis C

Question 2

Hepacivirus genus; Flaviviridae family (yellow fever, dengue, etc.)

Answer 2

Hep C

Question 3

What are the structural proteins of Hep C?

Answer 3

Core, and Envelope E1 and E2

Question 4

Very high replication rate

Half-life = few hours

Answer 4

Hep C

Question 5

Like HIV, Hep C has a high

Answer 5

Genetic variability

Question 6

Hep C has lack of proof-reading function of viral

Answer 6

RNA polymerase

Question 7

The most common genotype of Hep C ion the US is

Answer 7

Genotype 1

Question 8

Principal cause of death from liver disease and leading indication for liver transplant in U.S.

Answer 8

Hep C

Question 9

Often asymptomatic; if clinical illness, infant, young women, more likely to clear virus

Answer 9

Acute Hep C infection

Question 10

With acute infection, anti-HCV can be negative for

Answer 10

Months

Question 11

Characterized by asymptomatic fatigue, normal ALT/AST

Answer 11

Chronic Hep C

Question 12

What percentage of chronic Hep C patients progress to advanced liver disease?

Answer 12

25%

Question 13

Type II mixed cryoglobulinemia, glomerulonephritis, lymphoma, and neuropathy are all complications of

Answer 13

Hep C infection

Question 14

If you received clotting factors made before 1987, you should be screened for

Answer 14

Hep C

Question 15

Increases linearly with Hep C infection?

Answer 15

Hepatocellular carcinoma

Question 16

To eradicate HCV as reflected in a sustained virologic response (SVR) to therapy

Answer 16

Treatment goals in chronic HCV

Question 17

Absence of HCV RNA (by PCR) 12 weeks after completion of treatment course

Answer 17

SVR

Question 18

Is associated with 99% chance of being HCV RNA negative in long-term follow up

Answer 18

SVR

Question 19

What is the standard treatment for the HCV genotype 1?

Answer 19

Alpha 2a/2b pegylated interferon + ribavirin

Question 20

With completion of a full course of alpha 2a/2b pegylated interferon + ribavirin, the SVR is

Answer 20

40-50%

Question 21

Response to genotype 1 therapy is lower in

Answer 21

African Americans

Question 22

NS3/4 protease inhibitor used to treat HCV genotype 1

Answer 22

Simeprevir

Question 23

Nucleotide polymerase inhibitor used to treat HCV genotype 1

Answer 23

Sofosbuvir

Question 24

An NS5A inhibitor used to treat HCV genotype 1

Answer 24

Ledipasvir

Question 25

A protease inhibitor used to treat HCV genotype 1

Answer 25

Paritaprevir/ritonavir

Question 26

An NS5B inhibitor used to treat HCV genotype 1

Answer 26

Dasabuvir

Question 27

Self-limited, with or without symptoms

Answer 27

Acute Hep B infection

Question 28

Characterized by persistence of HBsAg in serum

Answer 28

Chronic HBV infection

Question 29

Advanced liver disease; cirrhosis hepatocellular carcinoma, and co-infection with HIV, hepatitis C are complications of

Answer 29

HBV

Question 30

HBV infection is most prevalent in

Answer 30

Africa and Asia

Question 31

What are 3 serologic markers of HBV infection?

Answer 31

HBsAg, Anti-HBs, and HBcoreAg

Question 32

The best correlation of immunity is

Answer 32

Anti HBs

Question 33

Not measurable; structural component of nucleocapsid

Answer 33

HBcoreAg

Question 34

Appears early during acute infection and during flares of chronic hepatitis

Answer 34

Anti-HBcore IgM

Question 35

Lifelong marker of HBV infection, no correlate of activity or immunity

Answer 35

Anti-HBcore IgG/total

Question 36

Soluble nucleocapsid protein which strongly correlates with level of viral replication

Answer 36

HBeAg (Hep B e antigen)

Question 37

Important correlate of reduced viral replication and necroinflammatory activity in some patients

Answer 37

Anti-HBe

Question 38

Lower in chronic HBV infection

Answer 38

Anti-HBs and Anti-HBe

Question 39

Higher in chronic HBV infection than acute

Answer 39

HBeAg and HBsAg

Question 40

Characterized by a Replicative phase with acute liver disease (immune clearance), and a non-replicative phase with remission of liver disease

Answer 40

Chronic HBV

Question 41

What are the three phases of Chronic HBV?

Answer 41

1. ) Immune tolerance phase 2. ) Replicative phase 3. ) Non-replicative phase

Question 42

Characterized by normal ALT, asymptomatic, high HBV DNA levels, and HBeAG (+)

Answer 42

Immune tolerance phase

Question 43

What is the characteristic of HBeAg for the immune tolerance phase?

Answer 43

HBeAg (+)

Question 44

There is a high rate of maternal-fetal transmission for the

Answer 44

Immune-tolerance phase

Question 45

AST/ALT may be elevated intermittently or constantly during the

Answer 45

Immune clearance phase of HBV

Question 46

During the immune clearance phase of HBV, severe hepatitis may occur leading to more rapid progression to

Answer 46

Cirrhosis

Question 47

What is a major serological characteristic of the non-replicative phase?

Answer 47

HBeAg (-) > Anti-HBe (+)

Question 48

During the non-replicative phase of HBV, we also see

Answer 48

HBsAg (+)

Question 49

HBV DNA is low or undetectable, and ALT is normal/mildly elevated during the

Answer 49

Non-replicative phase of HBV

Question 50

There is a reduced inflammation score on biopsy during the

Answer 50

Non-replicative phase

Question 51

The biochemical response to therapy in chronic HBV is normal/reduction of

Answer 51

ALT/AST

Question 52

Serologically, when treating chronic HBV, we expect to see conversion of

Answer 52

HBeAG and HBsAg to Anti-HBe and HBs respectively

Question 53

Lamivudine, Adefovir , Entecavir, Tenofovir, and Interferon are all

Answer 53

Anti-virals for HBV infection

Question 54

First nucleoside/tide agent for HBV infection -Low cost but high resistance risk limits long-term benefit

Answer 54

Lamivudine

Question 55

The resistance rate to lamivudine is up to 20% at one year, however at 5 years, it is at

Answer 55

70%

Question 56

Second antiviral developed for HBV -Slower antiviral response than other agents: HBV DNA fall

Answer 56

Adefovir

Question 57

The dose of adefovir is 10 mg. Higher doses are associated with

Answer 57

Creatinine elevations

Question 58

Not recommended for primary therapy when tenofoviris available -Used for tenofovir-resistant patients

Answer 58

Adefovir

Question 59

At 5 years, the resistance to adefovir is

Answer 59

30%

Question 60

Recommended for 12 months post HBeAg conversion indefinite for Anti-HBe patients

Answer 60

Adefovir

Question 61

Adefovir-resistant mutants have diminished susceptibility to

Answer 61

Tenofovir

Question 62

Cyclopental guanosine analogue -Not recommended for pts. with lamivudine-resistant mutants because of lesser antiviral effect and ↑ risk of resistance

Answer 62

Entecavir

Question 63

Dose is 0.5 mg; may be increased to 1.0 mg in cirrhosis or very high HBV DNA levels

Answer 63

Entecavir

Question 64

Nucleotide reverse transcriptase inhibitor -Comparable viral suppression to entecavir

Answer 64

Tenofovir

Question 65

No resistance mutations detected for HBV (0/585 pts. at 6 yrs.) -Treatment of choice for pts. with prior exposure to other nucleoside analogues (lamivudine)

Answer 65

Tenofovir

Question 66

Can cause decreased bone density -Not for use in children

Answer 66

Tenofovir

Question 67

Target –global eradication of chronic infection -Prevention of hepatocellular carcinoma

Answer 67

HBV vaccine

Question 68

What are the two yeast derived vaccines for HBV in the US?

Answer 68

Engerix and Recombivax

Question 69

What are the 3 dose regimens for HBV vaccine

Answer 69

0, 1, and 6 months

Question 70

An adequate response to the HBV vaccine is defined as Anti-HBs serum level of

Answer 70

Greater than 10 mIU/ml

Question 71

Causes acute hepatitis with no chronic infection -Transmitted by fecal to oral route

Answer 71

Hepatitis A virus

Question 72

Most adults from low income countries are immune to

Answer 72

Hepatitis A virus

Question 73

Hep A has no association with

Answer 73

Liver Cancer

Question 74

In the hepatovirus family, but with only a single serotype

Answer 74

HAV

Question 75

The highest prevalence of HAV is in

Answer 75

Africa and the middle east

Question 76

What is the incubation period for HAV?

Answer 76

15-50 days

Question 77

The replication site for HAV seems to be limited to the

Answer 77

Liver

Question 78

HAV is diagnosed by serology via

Answer 78

Anti-HAV IgM

Question 79

Contagious during the incubation period and for a week after jaundice appears

Answer 79

HAV

Question 80

Humans are the only known reservoir for

Answer 80

HAV

Question 81

Alum-adjuvanted vaccine for HAV prepared from cell culture

Answer 81

HAVRIX

Question 82

What are the protective anti-body levels for HAV vaccine?

Answer 82

10-20 mIU/ml

Question 83

The seroconversion to protective HAV antibodies takes

Answer 83

2-4 weeks

Question 84

Incorporated into the routine childhood immunization schedule in 2006 (given at ~ 12 months)

Answer 84

HAV vaccine

Question 85

Men who have sex with men, persons traveling to high/intermediate endemicity, HIV infection, and chronic liver disease (especially HCV) are indications for

Answer 85

HAV vaccine

Question 86

The current gold standard for the treatment of HCV genotype 1 is a triple drug therapy including

Answer 86

Peginterferon, ribavirin, and a protease inhibitor

Question 87

What are the two available protease inhibitors?

Answer 87

Telaprevir and boceprevir

Question 88

What is the anti-viral drug choice for pre-emptive therapy for HBV?

Answer 88

lamivudine or tenofovir/entecavir

Question 89

Asian patients moving from immune tolerance phase to immune clearance show progression to

Answer 89

Chronic liver diseae

Question 90

Any adult with chronic HBV can show progression to chronic

Answer 90

Liver disease

Question 91

Progression to chronic liver disease is also caused by co-infection of

Answer 91

HCV and HIV

Question 92

Patients who are HBeAg positive with increased HBV DNA may require

Answer 92

Longer courses of treatment

Question 93

Patients who are HBsAg and anti-HBs negative, but antiHBc positive, indicating prior infection, may also -Follow closely but without treatment

Answer 93

Reactivate

Question 94

For HBsAg negative patients, we want to give a high dose of

Answer 94

HBV vaccine