Hepatitis Flashcards
Hepatitis A virus:
- DNA/RNA
- Family
- Transmission
- RNA
- Picornavavirus
- Fecal-Oral
Who does HAV primarily effect?
Children, often before 11 y/o
Diagnosis of Acute infection depends on demonstrating what?
IgM anti-HAV
IgG anti-HAV indicates.
Acute or past infection
-persists for life
Hepatitis B virus:
- DNA/RNA
- Family
- Name of intact virion
- DNA
- Hepdnavirus
- Dane particle
HBV viral markers:
-HbsAg (surface antigen)
Indicates Active disease
-either acute infection or chronic carrier state
HBV viral markers:
-HBeAg (when is it produced?)
-Indicates chronic carriage with active viral replication
only produced when the virus in in replicating form
HBV viral markers:
- Anti-HBc (antibody to B core antigen)
- IgM
- Total antibodies (IgG/IgM)
- Present throughout lifetime of someone who has been INFECTED
- Acute infection
- Acute and Past infection
HBV viral markers:
-Anti-HBe (3)
- Found when HBe becomes negative
- Does NOT imply resolved infection or immunity
- Indicates chronic carrier without active viral replication
HBV viral markers:
-HBsAb (antibody vs surface antigen)
- Indicates resistance from infection
- Found in IMMUNIZED persons and those who have successfully cleared HBV infection
When do serologic markers for HBV emerge?
2-10 weeks following infection
What marker appears 1st following HBV infection; followed by which ones?
- HBsAg
- HBeAg
- IgM anti-HBc
T/F: HBV DNA is detectable in serum before HBsAg.
True
What serologic markers coincide with emergence of symptoms?
-Anti-HBc
What antibodies emerge when there is complete resolution of acute HBV infection?
- Anti-HBe
- Anti-HBs
What remains positive in patients who develop chronic HBV infection? (what is criteria for diagnosis)
HBsAg remains positive
-persistence for >6months
Persistent HBsAg without clinical hepatitis is called what
-Chronic Carrier State
Chronicity develops in % of:
- Healthy
- Immunocompromised adults
- Neonates infected transplacentally
- 5%
- 10%
- 90%
What is chronic HBs antigenemia associated with?
Polyarteritis Nodosum (PAD)
Which Hepatitis virus can only infect hepatocytes with HBV DNA?
HepD (HDV)
HBeAg - Chronic Hepatitis B is characterized by what? *3)
- Circulating HBV DNA
- Fluctuating aminotransferases
- Tendency towards fulminant hepatitis with liver failure
HBeAg - Chronic Hepatitis B results from what?
Mutations in the C or pre C region of the HBV genome in which a premature stop codon impairs synthesis of HBeAg
What are the 3 major applications for molecular assays in HBV?
- Making initial diagnosis of HBV
- Replicative vs. Nonreplicative Chronic HBV
- Response to therapy (undetectable HBV DNA is consiered a virologic response)
Those with ____ copies of HBV DNA/mL are considered replicative chronic HBV.
> 10^5 copies of HBV DNA
HBV Serology - No prior infection nor immunization:
- HBsAg
- Anti-HBc
- Anti-HBs
HBV Serology - No prior infection nor immunization:
- HBsAg - Neg.
- Anti-HBc - Neg.
- Anti-HBs - Neg.
HBV Serology - Prior immunization:
- HBsAg
- Anti-HBc
- Anti-HBs
HBV Serology - Prior immunization:
- HBsAg - Neg.
- Anti-HBc - Neg.
- Anti-HBs - Positive
HBV Serology - Acute HBV:
- HBsAg
- Anti-HBc
- Anti-HBs
HBV Serology - Acute HBV:
- HBsAg - Positive
- Anti-HBc - Positive (IgM)
- Anti-HBs - Neg.
HBV Serology - Chronic HBV:
- HBsAg
- Anti-HBc
- Anti-HBs
HBV Serology - Chronic HBV:
- HBsAg - Positive
- Anti-HBc - Positive
- Anti-HBs - Negative
HBV Serology - Resolved HBV:
- HBsAg
- Anti-HBc
- Anti-HBs
HBV Serology - Resolved HBV:
- HBsAg - Neg.
- Anti-HBc - Positive (IgM&IgG)
- Anti-HBs - Positive
Hepatitis C virus family.
Flavivirus
What is the most common cause of transfusion associated viral hepatitis?
HepC
What percentage of those infected develop chronic HCV?
60%
What percentage of those with chronic HCV develop cirrhosis?
15%
What percentage of those with cirrhosis develop HCC?
5%
What are the extrahepatic manifestations of HCV? (3)
- Mixed cryoglobulinemia
- Glomerulonephritis
- Aplastic anemia
Diagnosis of HCV is based on which 3 assays?
- EIA based assays for anti-HCV antibodies
- HCV RNA
- Recombinant Immunoblot Assay (RIBA)
HCV Assay results - Early HCV infection (<3 months):
- Anti-HCV (EIA)
- RIBA
- HCV RNA
HCV Assay results - Early HCV infection (<3 months):
- Anti-HCV (EIA) - Neg.
- RIBA - Neg.
- HCV RNA - Positive
HCV Assay results - Current HCV infection (acute or chronic):
- Anti-HCV (EIA)
- RIBA
- HCV RNA
HCV Assay results - Current HCV infection (acute or chronic):
- Anti-HCV (EIA) - Positive
- RIBA - Positive
- HCV RNA - Positive
HCV Assay results - Cleared/resolved prior HCV infection:
- Anti-HCV (EIA)
- RIBA
- HCV RNA
HCV Assay results - Cleared/resolved prior HCV infection:
- Anti-HCV (EIA) - Positive
- RIBA - Positive
- HCV RNA - Negative
HCV Assay results Interpretation:
- Anti-HCV (EIA) - Positive
- RIBA - Neg./Indeterminate
- HCV RNA - Neg.
False Positive anti-HCV EIA
What is the endpoint of treatment for HCV infection?
Sustained Virologic Response (SVR):
-Undetectable HCV RNA for 24 weeks after the end of treatment
What is the most common HCV genotype in the US?
-Subclass?
HCV genotype 1 (70%)
- Type 1a (60%)
- Type 1b (10%)
Which HCV genotype is more likely to develop resistance to treatment?
HCV genotype 1a
Is Hepatitis E virus (HEV) a DNA or RNA virus
RNA (HEV)
How is HEV transmitted?
Who does it typically affect?
- fecal-oral
- young adults (15-35 y/o)
HEV is more virulent in what population?
Pregnant women
-mortality rate of 30%
*overall mortality is 1%
T/F: Chronic HEV infections are rare.
True
Hepatitis G virus (GBV C virus):
- DNA or RNA
- Virus Family
- Transmission
- Chronicity
- RNA
- Flaviviridae family
- Parenteral transmission
- Chronic infection is common
*Not clearly demonstrated to cause clinical hepatitis
What are other viruses that cause hepatitis? (5)
- EBV
- CMV
- HSV
- VZV
- Yellow Fever
