Hepatitis and Hep Treatment Flashcards
Most common viral hep worldwide?
Hep A
Spread of hep A?
Fecal-oral
Does hep A have a vaccine?
yes
Life of hep A
acute, benign, self limited (<2mo)
How is hep B transmitted?
Perinatal, blood, sex IVdrugs
How does hep B look in adults?
Unlikely to be chronic
How does hep B look in kids
almost always chronic
Serologies if vaccinated for hep B
+surface Ab only (only there if cured or immunized)
Serologies if have chronic for hep B
+surface Ag
+surface core IgG
elevated DNA
Serologies if acute for hep B
+surface Ag
+core (IgM or IgG)
elevated DNA
What is the only DNA hep virus?
Hep B….stable DNA so harder to treat
How do you treat hep B
Interferon
How do you treat babies whos moms have hep B
vaccine at birth
What is e antigen?
e antigen is secreted only if virus is replicating. Indicates active virus
What is e antibody
e antibody indicates robust immune response dec virus
What does the most injury to liver in hep B?
immune response
What will your labs look like with immune tolerance to hep B?
- no ALT
- High DNA
- eAg pos/eAb neg
- ->typical initial phase of perinatal acquired infection
What will your labs look like with chronic hep
- ALT high
- High DNA
- eAgpos/eABneg
What will your labs look like with seroconversion to inactive carrier state?
ALT transient inc then nl
Low DNA
eAg neg/eAb pos
eAg and chronic hep
can be neg or pos
What are the indications for HBV treatment?
- elevated ALT
- elevated HBV DNA
- cirrhosis and detectable HBV dna
What are the goals of HBV therapy
- dec risk of hepatic decompensation and HCC
- Normalization of ALT
- Histological improvement
How do most of the HBV drugs work?
Viral polymerase inhibitors, oral or interferon
What is special about eAg negative patients regarding therapy?
They relapse when you go off interferon therapy
What are some advantages to interferon therapy?
- no viral resistance (immune activator, doesn’t work on virus)
- Finite course of therapy
What are some disadvantages of interferon?
- Not great with high HBV DNA and low ALT
- Side effects
- Cant use with decompensated liver dis
- High relapse with eAg neg
In what setting would you see hep D?
Only in setting of hep B infection
What does hep D inc risk of?
Fulminant liver
How is hep D spread?
percutaneously
What kind of virus is hep C
RNA
Does genotype of hep C impact severity?
No, but it impacts treatment response
What constitutes decompensated cirrhosis?
- ascites
- HE
- Jaundice
- Variceal bleeding
Who is more likely to have hep C M or F?
M
What is the gold standard for treatment of hep c?
Sustained viral response (SVR)
-absence of detectable HCV in blood 6 mo after end of therapy
What is the chance of relapse after SVR is reached?
<1%
What are the two treatments for hep c?
Pegylated interferon alpha (IV) and ribavirin (oral)
What are the adverse events of interferon?
- flu - like symp
- depression
- pancytopenia (bone marrow supp)
- immune disease activation
- wt loss
- infection
- worsening of cirrhosis
How should ribavirin be administered
INEFFECTIVE as monotherapy! Use with interferon
What are the adverse events of ribavirin?
- non-immune hemolytic anemia
- rash
- dyspnea (difficulty breathing)
- teratogenic
- contraindicated in chronic renal failure
On old treatment, what was predictive of drug’s success?
Rapid decline of viral laod inc likelihood of SVR
Can you use monotherapy for hep C drugs?
NO! virus will rebound
What are DAA agents?
Target more specific pathways in virus. Can be used for one strain or all.
end in -vir
Describe the peaks in hep C life cycle
- inc HCV then dec
- Inc ALT after HCV hits peak
- Inc anti-HCV at around wk 10
What % hep is responsive to therapy?
85-95%
What kind of virus is hep E?
RNA
What is special about hep E worldwide?
most common cause of epidemic enterically transmitted hep
How is hep E transmitted?
Fecal-Oral, immunosuppressed
Who is hep E most dangerous for
pregnant women are at higher risk for fulminant hep
What rises quickly in hep E?
ALT rises with IgM
What hep is most likely to give you fulminant hep?
hep D
Which heps give you chronic infections?
hep B in infants mostly and hep C and hep D superinfection (ie get hep D after already had hep B)
