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Hepatitis Flashcards

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1
Q

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

A

Hepatitis C

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2
Q

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

A

Hep C

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3
Q

What are the structural proteins of Hep C?

A

Core, and Envelope E1 and E2

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4
Q

Very high replication rate

Half-life = few hours

A

Hep C

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5
Q

Like HIV, Hep C has a high

A

Genetic variability

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6
Q

Hep C has lack of proof-reading function of viral

A

RNA polymerase

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7
Q

The most common genotype of Hep C ion the US is

A

Genotype 1

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8
Q

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

A

Hep C

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9
Q

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

A

Acute Hep C infection

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10
Q

With acute infection, anti-HCV can be negative for

A

Months

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11
Q

Characterized by asymptomatic fatigue, normal ALT/AST

A

Chronic Hep C

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12
Q

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

A

25%

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13
Q

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

A

Hep C infection

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14
Q

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

A

Hep C

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15
Q

Increases linearly with Hep C infection?

A

Hepatocellular carcinoma

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16
Q

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

A

Treatment goals in chronic HCV

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17
Q

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

A

SVR

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18
Q

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

A

SVR

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19
Q

What is the standard treatment for the HCV genotype 1?

A

Alpha 2a/2b pegylated interferon + ribavirin

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20
Q

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

A

40-50%

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21
Q

Response to genotype 1 therapy is lower in

A

African Americans

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22
Q

NS3/4 protease inhibitor used to treat HCV genotype 1

A

Simeprevir

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23
Q

Nucleotide polymerase inhibitor used to treat HCV genotype 1

A

Sofosbuvir

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24
Q

An NS5A inhibitor used to treat HCV genotype 1

A

Ledipasvir

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25
Q

A protease inhibitor used to treat HCV genotype 1

A

Paritaprevir/ritonavir

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26
Q

An NS5B inhibitor used to treat HCV genotype 1

A

Dasabuvir

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27
Q

Self-limited, with or without symptoms

A

Acute Hep B infection

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28
Q

Characterized by persistence of HBsAg in serum

A

Chronic HBV infection

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29
Q

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

A

HBV

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30
Q

HBV infection is most prevalent in

A

Africa and Asia

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31
Q

What are 3 serologic markers of HBV infection?

A

HBsAg, Anti-HBs, and HBcoreAg

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32
Q

The best correlation of immunity is

A

Anti HBs

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33
Q

Not measurable; structural component of nucleocapsid

A

HBcoreAg

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34
Q

Appears early during acute infection and during flares of chronic hepatitis

A

Anti-HBcore IgM

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35
Q

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

A

Anti-HBcore IgG/total

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36
Q

Soluble nucleocapsid protein which strongly correlates with level of viral replication

A

HBeAg (Hep B e antigen)

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37
Q

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

A

Anti-HBe

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38
Q

Lower in chronic HBV infection

A

Anti-HBs and Anti-HBe

39
Q

Higher in chronic HBV infection than acute

A

HBeAg and HBsAg

40
Q

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

A

Chronic HBV

41
Q

What are the three phases of Chronic HBV?

A
  1. ) Immune tolerance phase
  2. ) Replicative phase
  3. ) Non-replicative phase
42
Q

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

A

Immune tolerance phase

43
Q

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

A

HBeAg (+)

44
Q

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

A

Immune-tolerance phase

45
Q

AST/ALT may be elevated intermittently or constantly during the

A

Immune clearance phase of HBV

46
Q

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

A

Cirrhosis

47
Q

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

A

HBeAg (-) > Anti-HBe (+)

48
Q

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

A

HBsAg (+)

49
Q

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

A

Non-replicative phase of HBV

50
Q

There is a reduced inflammation score on biopsy during the

A

Non-replicative phase

51
Q

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

A

ALT/AST

52
Q

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

A

HBeAG and HBsAg to Anti-HBe and HBs respectively

53
Q

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

A

Anti-virals for HBV infection

54
Q

First nucleoside/tide agent for HBV infection

-Low cost but high resistance risk limits long-term benefit

A

Lamivudine

55
Q

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

A

70%

56
Q

Second antiviral developed for HBV

-Slower antiviral response than other agents: HBV DNA fall

A

Adefovir

57
Q

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

A

Creatinine elevations

58
Q

Not recommended for primary therapy when tenofoviris available

-Used for tenofovir-resistant patients

A

Adefovir

59
Q

At 5 years, the resistance to adefovir is

A

30%

60
Q

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

A

Adefovir

61
Q

Adefovir-resistant mutants have diminished susceptibility to

A

Tenofovir

62
Q

Cyclopental guanosine analogue

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

A

Entecavir

63
Q

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

A

Entecavir

64
Q

Nucleotide reverse transcriptase inhibitor

-Comparable viral suppression to entecavir

A

Tenofovir

65
Q

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)

A

Tenofovir

66
Q

Can cause decreased bone density

-Not for use in children

A

Tenofovir

67
Q

Target –global eradication of chronic infection

-Prevention of hepatocellular carcinoma

A

HBV vaccine

68
Q

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

A

Engerix and Recombivax

69
Q

What are the 3 dose regimens for HBV vaccine

A

0, 1, and 6 months

70
Q

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

A

Greater than 10 mIU/ml

71
Q

Causes acute hepatitis with no chronic infection

-Transmitted by fecal to oral route

A

Hepatitis A virus

72
Q

Most adults from low income countries are immune to

A

Hepatitis A virus

73
Q

Hep A has no association with

A

Liver Cancer

74
Q

In the hepatovirus family, but with only a single serotype

A

HAV

75
Q

The highest prevalence of HAV is in

A

Africa and the middle east

76
Q

What is the incubation period for HAV?

A

15-50 days

77
Q

The replication site for HAV seems to be limited to the

A

Liver

78
Q

HAV is diagnosed by serology via

A

Anti-HAV IgM

79
Q

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

A

HAV

80
Q

Humans are the only known reservoir for

A

HAV

81
Q

Alum-adjuvanted vaccine for HAV prepared from cell culture

A

HAVRIX

82
Q

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

A

10-20 mIU/ml

83
Q

The seroconversion to protective HAV antibodies takes

A

2-4 weeks

84
Q

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

A

HAV vaccine

85
Q

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

A

HAV vaccine

86
Q

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

A

Peginterferon, ribavirin, and a protease inhibitor

87
Q

What are the two available protease inhibitors?

A

Telaprevir and boceprevir

88
Q

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

A

lamivudine or tenofovir/entecavir

89
Q

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

A

Chronic liver diseae

90
Q

Any adult with chronic HBV can show progression to chronic

A

Liver disease

91
Q

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

A

HCV and HIV

92
Q

Patients who are HBeAg positive with increased HBV DNA may require

A

Longer courses of treatment

93
Q

Patients who are HBsAg and anti-HBs negative, but antiHBc positive, indicating prior infection, may also

-Follow closely but without treatment

A

Reactivate

94
Q

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

A

HBV vaccine

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