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Micro Final > Hepatitis Cx Presentations > Flashcards

Hepatitis Cx Presentations Flashcards

1
Q

What is the clinical significance behind the high genetic variability of Hepatitis C virus?

A

High replication rate and a lack of proof-reading function of viral RNA polymerase limits the ability to develop vaccines and for the host immune system to control the virus. This virus has 6 serotypes, in which Genotype 1 is common in the US.

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2
Q

Define the major trend in the incidence of Hepatitis C

A

Hepatitis C incidence rates REFLECT the growing rates of IV drug use in the opioid epidemic. 60-80% of people with Hep C develop a CHRONIC infection.

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3
Q

What age group has the HIGHEST increase in Hep C incidence rates?

A

Ages 20 - 29

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4
Q

List at least 5 factors that propagate the transmission of HCV.

A
  1. IV Drug users
  2. Multiple partners
  3. MSM (homosexuals)
  4. Incarceration
  5. Contaminated piercings
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5
Q

What proportion of HCV patients will develop a chronic infection? Name 3 end-stage manifestations of the disease.

A

80% develop chronic HCV infection;

Cirrhosis, jaundice or carcinoma can develop as end-stage factors.

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6
Q

Briefly describe the diagnostic tests used for HCV.

A
  1. Antibody - 99% sensitive and specific

2. Real time PCR (aka NAAT)

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7
Q

What 2 non-invasive tests can be used to assess the extent of liver fibrosis in an HCV patient?

A
  1. Fibrosure - combination tests that gauges the degree of fibrosis
  2. Elastography - ultrasound measures liver stiffness.
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8
Q

Classify the type of virus that Hepatitis C is.

A

HCV = enveloped, (+) sense RNA virus that is a human infection. It can now be curable and eradicated if everyone in the world were treated for it.

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9
Q

What is the importance of SVR as it pertains to HCV treatment?

A

Sustained Virologic Response after 12 weeks of oral anti-viral regimen is the measure of cure for Hep C. People with SVR > 12 have lower mortality rates, cirrhosis and less need for liver transplant

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10
Q

What are some common treatments that can be used for Hepatitis C infection?

A
  1. Ribavirin
  2. Protease Inhibitors
  3. IFN-alpha
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11
Q

What is the Direct Acting Antiviral Treatment (DAA) for HCV.

A

This is an oral regimen that targets specific non-structural proteins for HCV to impair viral replication

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12
Q

What is an example of a “pan-genotypic” protease inhibitor (DAA)?

A

Velpatasvir is a pan-genotypic DAA. It’s highly effective against all 6 genotypes.

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13
Q

In what 3 ways does Hepatitis B differ from Hepatitis C?

A

Hepatitis B:

  1. enveloped DNA virus
  2. Only 5-10% develop chronic infection
  3. majority of people have (+) serology for HBV as asymptomatic children (inactive carrier state)
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14
Q

What patient population is most likely to acquire chronic HBV?

A

Perinatal or young children are likely to develop chronic HBV infection. They present in an inactive carrier state.

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15
Q

What are the relative levels of AST and ALT liver enzymes in alcoholic vs viral hepatitis?

A

Alcoholic Hepatitis = AST “S for sauced” is greater;

Viral Hepatitis = ALT is usually greater

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16
Q

How infectious is HBV compared to the other hepatitis infections? How is it transmitted?

A

HBV is the most infectious hepatitis virus, even more infectious than HIV. It’s transmitted via IV drug users, sex or mixing of blood during birth.

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17
Q

Any patient with chronically elevated _____ should be tested for HBV and HCV.

A

Chronically elevated ALT (indicates viral hepatitis)

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18
Q

What is a diagnostic marker for Hepatitis B infection? What of HBV immunity?

A

HbsAg (HBV antigen) is the infection diagnostic marker. This remains positive throughout life. Anti-HBs is a marker for immunity.

19
Q

What is the HBV diagnostic marker for acute infection?

A

Anti-HBc IgM = marker for ACUTE infection;

very rare to get a positive

20
Q

What is the HBV diagnostic marker for any previous infection (no matter the stage of life)?

A

Anti-HBc IgG = marker of PREVIOUS infection, no matter when you someone got infected

21
Q

What is the diagnostic marker for very active viral replication of HBV? What reflects immune control for this?

A

HBeAg (marker for the transition of tolerant to ACTIVE PHASE in perinatal infection);
Seroconversion to Anti-Hbe

22
Q

What is the expected hepatitis B serological panel for a young adult up to date with their vaccines/ (HBsAg, anti-HBc, anti-HBs)

A

HBsAg (negative), anti-HBc (negative), anti-HBs (POSITIVE)

23
Q

What is the diagnostic serology for someone who is acutely infected with HBV? (HBsAg, anti-HBc, IgM anti-HBc)

A

IgM anti-Hbc (core = POSITIVE), HBsAg and anti-HBc (positive too)

24
Q

What are the unique diagnostic serology markers for someone chronically infected with HBV? (IgM anti-HBc, anti-HBs, HBsAg, anti-HBc)

A

IgM anti-HBc and anti-HBs (both NEGATIVE); HBsAg and anti-HBc (both positive)

25
Q

Define the immune tolerance phase of Hepatitis B.

A

Levels of viral DNA remain high from perinatal to young adult years. Liver enzymes are normal and there is no liver pathology.

26
Q

Define the immune clearance phase of Hepatitis B.

A

In an infected person’s 20s-30s a seroconversion of HBeAg to anti-HBe occurs. Liver enzymes go up and viral DNA begins to decrease.

27
Q

Define the inactive carrier state of Hepatitis B patients.

A

At infected person’s 40s, viral DNA is low and liver enzymes are normal or slightly elevated.

28
Q

What 2 substances are used to treat chronic HBV disease?

A
  1. Alpha-interferon

2. Reverse-transcriptase inhibitor 3TC

29
Q

Define the HBV surface antigen.

A

HbsAg is present in both infectious virions and empty HBV particles. It is the main diagnostic marker for infectious HBV disease.

30
Q

Define the HBV core antigen.

A

HbcAg is present only in infectious virions.

31
Q

Define the Hbe antigen

A

HbeAg is present in infectious virions and free serum. It correlates with viremia and infectivity.

32
Q
  1. What treatments can be used for Hepatitis B?

2. What are the desired effects of these antivirals?

A
  1. Nucleoside/ nucleotide analogues (Lamivudine - 70% resistance, Entecavir, Tenofovir);
  2. Reduce AST/ALT, HBV DNA (lower viral load), and seroconversion of HBeAg to anti-HBe. Reduce inflammation and viral replication.
33
Q

Describe the immunization protocol for children born to HBV + or unknown mothers.

A
  1. HBV vaccine within 12 hours
  2. Hep B hyperimmune globulin at birth
  3. Subsequent vaccine at 1 and 6 months
  4. Monitor baby for HBsAg and anti-HBs (they will be + initially)
34
Q

How does Hepatitis A differ from HBV and HCV?

A
  1. NO CHRONIC infection (only acute)
  2. No anti-viral treatment available (only inactivated vaccine or pooled human Ig)
  3. Single serotype (everybody with response has the same AB against Hep A)
35
Q

List the symptoms associated with a Hep A infection.

A
  1. Children are asymptomatic

2. Prodrome: flu-like illness dark urine, pale/clay colored stools, jaundice, enlarged liver

36
Q

Describe the spread, clinical features, diagnosis and treatment of Hepatitis A.

A

Tsm: fecal/oral spread;
Cx: flu-like symptoms, jaundice, dark urine, pale stool;
Dx: serology, anti-HAV IgM, elevations of bilirubin, AST/ALT
Tx: no antivirals, only vaccines (i.e. HAVRIX) and pooled human Ig

37
Q

What does IgM antibody to Hepatitis A mean? What of IgG antibody to HAV?

A

IgM antibody is usually positive for months at first elevation of liver function. IgG antibody follows after IgM, where a (+) confers IMMUNITY. There is no evidence of recurrent infection.

38
Q

Describe the pre-exposure phrophylaxis of HAV for the following populations:

  1. Children < 12 months
  2. Persons 12 months - 40 years
  3. Persons > 40 years
A
  1. Pooled Human Ig (0.02 ml/kg)
  2. HAV vaccination
  3. Either pooled human Ig or vaccination
39
Q

What populations are most likely to receive vaccinations for pre-exposure to Hepatitis A.

A

International travelers, MSM, illicit drug users, persons with chronic liver disease (HBV, HCV)

40
Q

What therapy is used to treat Hep B, Hep C, malignant melanoma Kaposi’s Sarcoma and HHV 8?

A

Interferon-alpha

41
Q

What antivirals are used to treat Hepatitis C?

A

Simeprevir = NS3/4 protease inhibitor; Ribavarin (guanosine analog) + Interferon-alpha

42
Q

What is the pan-genomic drug that works effectively against all 6 genotypes of Hep C?

A

Mavyret (Glecaprevir + Pibrentasvir) works for the duration of only 8 weeks as compared to others (at 12 weeks).

43
Q

What is the significance of Anti-HBc?

A

Anti-HBcore is a marker that remains (+) for someone who may have been infected with HBV earlier. This will persist in the patient’s serum throughout life (even after recovery).

Micro Final (12 decks)

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