Hepatitis Viruses

Question 1

how many known hepatitis viruses are there?

Answer 1

6–not phlyogenically related

Question 2

what do all hepatitis viruses have in common?

Answer 2

they all primarily affect hepatocytes and cause hepatitis on first infection

Question 3

what should you do before doing a virology work up for hepatitis?

Answer 3

rule out pharmaceutical causes of hepatitis

Question 4

what virus is Hep A caused by and how is it classified?

Answer 4

picornavirus. ssRNA with naked icosahedral capsid

Question 5

can Hep A recur?

Answer 5

no

Question 6

how is Hep A transmitted and what is the major cause of its symptoms?

Answer 6

fecal-oral and hepatitis is mostly immunogenic

Question 7

what is the most likely scenario for Hep A contraction?

Answer 7

subclinical infection

Question 8

what is a rare cause of mortality in Hep A patients?

Answer 8

fulminant hepatitis

Question 9

what are the symptoms caused by Hep A?

Answer 9

fever, jaundice, gastroenteritis, dark unine and pale feces

Question 10

what historical features of Hep A are relevant?

Answer 10

vaccination, foreign travel, daycare and shellfish consumption

Question 11

what lab tests are available for Hep A?

Answer 11

serology (differentiate between acute and resolved with IgM vs IgG) and serum ALT (liver damage)

Question 12

how do you treat Hep A?

Answer 12

fluids and monitoring while discontinuing other liver strains (alcohol and medications)

Question 13

how is Hep A prevented?

Answer 13

vaccine and Ig prophylaxis

Question 14

what virus is Hep B caused by and how is it classified?

Answer 14

hepadnavirus: small enveloped DNA virus (partially double stranded)

Question 15

what viral particles are found in serum of a HBV infected person?

Answer 15

virions and incomplete decoys

Question 16

a patient cannot be infected twice with hepatitis B. True or false?

Answer 16

true

Question 17

what does replication of HBV leave behind in the cell?

Answer 17

integrated viral DNA

Question 18

how is HBV transmitted?

Answer 18

blood, sex and birthing

Question 19

what is the most common course of HBV and what is the alternative?

Answer 19

most people have acute hepatitis and then clear the virus but some have a chronic infection (10%)

Question 20

what are some possible outcomes of chronic HBV?

Answer 20

cirrhosis (immunogenic), kidney damage and arthritis (accumulation of immune complexes) and hepatic cell carcinoma (integrated viral DNA)

Question 21

what laboratory tests are available for HBV?

Answer 21

serology (to test clearance), serum ALT and optional PCR and biopsy

Question 22

how should acute HBV be treated?

Answer 22

supportive care

Question 23

How should chronic HBV be treated?

Answer 23

if there is damaging infection, can treat with polymerase inhibitors and pegylated interferon

Question 24

how can HBV be prevented

Answer 24

vaccineation and Ig prophylaxis

Question 25

why does liver transplant fail with HBV carriers?

Answer 25

new liver cells will become infected with virions outside of the liver

Question 26

what virus is Hep C caused by and how is it classified?

Answer 26

flavivirus, enveloped +ssRNA

Question 27

what are two major differences between Hep B and Hep C?

Answer 27

there is no vaccine for HCV and there is a much higher potential for chronic infection (85%)

Question 28

how is HCV transmitted?

Answer 28

by blood and less efficiently by sex

Question 29

what is the treatment for acute HCV?

Answer 29

pegylated interferon to reduce risk of chronic infection

Question 30

what is the treatment for chronic HCV?

Answer 30

combined therapy to achive sustained viral response: ribavirin, protease inhibitors and pegylated interferon

Question 31

what determines the length of treatment for HCV?

Answer 31

the serotype types 2 and 3 have >50% recovery with 6 months types 1 and 4 have <50% recovery with 1-2 years

Question 32

what should be monitored during HCV treatment?

Answer 32

liver function, kidney function and blood and viral RNA levels

Question 33

why do many HCV patients discontinue treatment or reduce their dose?

Answer 33

interferon has many bad side effects

Question 34

what should be considered if HCV treatment fails?

Answer 34

living donor liver transplant

Question 35

why are living donor transplants usually more successful than cadaver transplants?

Answer 35

they can be scheduled so the patient can be treated with a short hard course of interferon to clear extra hepatic virus reservoirs

Question 36

what are some complications of chronic HCV?

Answer 36

liver failure, cirrhosis, hepatocellular carcinoma and death

Question 37

what laboratory tests are available for HCV?

Answer 37

diagnosa by EIA and genotype with RIBA | judge severity of disease by liver biopsy