Hepatitis Viruses

Question 1

cirrhosis is most common in which hepatitis viruses

Answer 1

HBV+-D

HCV

Question 2

structure/genome of hepatitis B virus

Answer 2

enveloped, icosahedral

partially dsDNA

Question 3

what does the HBV dsDNA do upon entering the nucleus

Answer 3

dsDNA becomes cccDNA

cccDNA is fo life; cant get rid of that shit

Question 4

transmission of HBV

Answer 4

sex
parenteral
perinatal(70-90% transmission w/out treatment)

Question 5

child vs adult risk of progressing to chronic HBV

Answer 5

30-90% chance for children <5% chance for healthy adults

Question 6

hepatocarcinoma in HBV vs HCV

Answer 6

due to HBV DNA entering the nucleus, hepatocarcinoma can occur during any time in the disease

for HCV, hepatocarcinoma only occurs after cirrhosis after an extended chronic period

Question 7

values for a resolved HBV patient
HBsAg = 
HBsAb = 
HBcAb(IgG) = 
HBV DNA =

Answer 7

HBsAg = negative
HBsAb = positive
HBcAb(IgG) = positive(acute IgM +)
HBV DNA = negative

Question 8

values for a chronic HBV patient
HBsAg = 
HBsAb = 
HBcAb(IgG) = 
HBV DNA =

Answer 8

HBsAg = positive
HBsAb = negative (probably why its chronic)
HBcAb(IgG) = positive(acute IgM)
HBV DNA = positive

Question 9

values for a patient with HBV vaccine
HBsAg = 
HBsAb = 
HBcAb(IgG) = 
HBV DNA =

Answer 9

HBsAg = negative
HBsAb = positive
HBcAb(IgG) = negative
HBV DNA = negative

Question 10

1st line treatment for HBV patients(liver damage)

Answer 10

tenofovir, entecavir

Question 11

prevention therapy for HBV

indications?

Answer 11

Hep B immunoglobulin
Hep B Vaccine

all children should be vaccinated
immunoglobulin can be given to adverse exposures and/or infants of HBsAg positive mothers

Question 12

key points for HCV life cycle

Answer 12

• no integration into host genome
• non-structural proteins are targets for therapy
• relies on host biosynthetic pathways(ER)
• HCV RNA polymerase is VERY prone to error

Question 13

most common source of transmission for HCV?

Answer 13

parenteral(IDU)

sex(rare)

Question 14

what is the prognosis for HCV?

Answer 14

prognosis is good!
cirrhosis takes a while to come about
there is good treatment for HCV(curable!)

Question 15

% of pt from acute HCV that progress to chronic

% that get cirrhosis from chronic group

Answer 15

85% get chronic HCV

20% get cirrhosis

Question 16

symptom severity in children vs adults for HBV

Answer 16

symptoms are much more mild for children

Question 17

treatment for HCV

indications?

Answer 17

HCV-1,4 = sofosbuvir(NS5A inhibitor)
HCV2,3 = sofosbuvir + ribavirin(12wk for 2, 24wk for 3)

Question 18

SVR

Answer 18

sustained virologic response

aviremia(undetectable) following HCV treatment

Question 19

Heptatitis A transmission

Answer 19

fecal-oral(OYSTERS)
blood exposure(rare)

Question 20

describe the prognosis/clinical features of hepatitis A infections

Answer 20

discrete onset
jaundice, elevated liver enzymes, dark urine, etc
virus is shed in stool
99% recover; NO CHRONIC FORM

Question 21

vaccines are avaiable for which hepatitis viruses

Answer 21

Hep B, Hep A

Question 22

prophylaxis for Hep A exposure

Answer 22

passive immunization(up to 2 weeks after exposure)

Question 23

hepatitis E structure/genome

Answer 23

naked icosahedral RNA virus

Question 24

transmission of hepatitis E

Answer 24

fecal-oral

Question 25

significance of hepatitis E

Answer 25

high mortality in pregos

chronic form reported in liver transplant patients

Question 26

what is required for Hep D infections

Answer 26

HBV co-infection OR HBV infeciton presence for superinfection of HDV

Question 27

significance of HDV superinfeciton?

Answer 27

HDV superinfected patients have a worse prognosis; more likely to have fulminant liver disease in acute phase, more likely to progress to cirrhosis

Question 28

most common population getting HDV infections on top of HBV?

Answer 28

IDUs