Hepatitis B

Question 1

What type of virus is hepatitis B?

Answer 1

enveloped, double stranded, circular, DNA virus

Question 2

What does hepatitis B attack?

Answer 2

It attacks the liver leading to acute (first 6 months) or chronic infection

Question 3

How is hepatitis B transferred?

Answer 3

1. blood exposure
2. sexual contact
3. sharing needles

Question 4

What are the complications of hepatitis B?

Answer 4

cirrhosis and hepatocellularcarcinoma (HCC)

Question 5

What is the vaccine schedule for hepatitis B?

Answer 5

3 shots: 0, 2, and 6 months

Question 6

What is the treatment for hepatitis B?

Answer 6

NRTIs

Question 7

What is HBsAg?

Answer 7

surface antigen that indicates live, active virus is present

Question 8

What is HBeAg?

Answer 8

indicates the presence of active replication of HBV as seen in phase 2 of chronic HBV infections

Question 9

What is anti-HBc?

Answer 9

Core antigen that is only positive if active virus is present or was present but cleared by the immune system

Question 10

What are IgM anti-HBs?

Answer 10

early antibody production that occurs in the acute phase of infection

Question 11

What are IgG anti-HBs?

Answer 11

Reflects immunity against HBV either from clearing infection or from immunization by vaccine

Question 12

Lab findings for a susceptible patient who has never been infected or vaccinated?

Answer 12

(-) HBsAg
(-) anti-HBc
(-) anti-HBs

Question 13

What lab findings indicate HBV immunity due to infection?

Answer 13

(-) HBsAg
(+) anti-HBc
(+) anti-HBs

Question 14

What lab findings indicate HBV immunity due to immunization?

Answer 14

(-) HBsAG
(-) anti-HBc
(+) anti-HBs

Question 15

What lab findings indicate acute HBV infection?

Answer 15

(+) HBsAg
(+) anti-HBc
(+) IgM anti-HBc
(-) anti-HBs
(+/-) HBeAg

Question 16

What lab findings indicate chronic HBV infection?

Answer 16

(+) HBsAg
(+) anti-HBc
(-) IgM anti-HBc
(-) anti-HBs

Question 17

Describe the immune tolerant phase?

Answer 17

1. ALT is normal
2. HBV DNA is > 1 million
3. (+) HBeAg
4. minimal inflammation/fibrosis

Question 18

Describe the immune active phase?

Answer 18

1. ALT is elevated
2. HBV DNA is ≥ 20,000
3. (+) HBeAg
4. mod-severe inflammation/fibrosis

Question 19

Describe the inactive phase?

Answer 19

1. ALT is normal
2. HBV DNA is < 2,000
3. (-) HBeAg
4. variable inflammation/fibrosis

Question 20

Describe the reactivation phase?

Answer 20

1. Elevated ALT
2. HBV DNA ≥ 2,000
3. (-) HBeAg
4. mod-severe inflammation/fibrosis

Question 21

What should a work-up consist of for HBV?

Answer 21

1. immunization status
2. comorbidities and family hx
3. baseline labs (renal and liver)
4. HIV, HCV, or HDV coinfection
5. baseline imaging of liver

Question 22

What is the MOA of the NRTIs?

Answer 22

they interfere with HBV polymerase and prevent the HBV DNA from making a copy of itself