IMSERO Flashcards
the most common hepatitis
due to easy transmission
HAV
self-limited, causing only acute diseases
HAV
aka INFECTIOUS HEPATITIS and has an abrupt onset
(short incubation hepatitis)
HAV
Incubation period: 15 – 50 days (ave: 28 days)
HAV
unlike HBV, it does not produce a coat protein and is not detectable in serum
only detectable in the feces
HAV
HAV MOT
1)fecal-oral/fecal matter ingestion, even in microscopic amounts, from:
* close person-to-person contact with infected person
* ingestion of contaminated food or drinks
2)NEW: direct oral-anal sexual contact with infected person
can release viral antigen in the small intestine, passed out during defecation
HAV
Persons at risk with this virus are the following:
* Travelers to region with intermediate/high rates of HAV
* Sex contacts of infected person
* Household members or caregivers of infected persons
* Men who have sex with men (homosexual intercourse)
* Users of certain illegal drugs (injections and non-injection) – very rare, but possible if the infected person have a severe hepatitis A infection that had reached the blood (VIREMIA)
* Persons with clotting-factor disorders (blood transfusions)
HAV
Who are the persons at risk for Hepatitis A virus?
Persons at risk for HAV:
* Travelers to region with intermediate/high rates of Hepa A
* Sex contacts of infected person
* Household members or caregivers of infected persons
* Men who have sex with men (homosexual intercourse)
* Users of certain illegal drugs (injections and non-injection) – very rare, but possible if the infected person have a severe hepatitis A infection that had reached the blood (VIREMIA)
* Persons with clotting-factor disorders (blood transfusions)
very rare but possible in cases when the virus reaches blood
seen in VERY SEVERE HAV cases (rarely)
viremia
presence of viruses in the blood
the spx recommended for antigen testing during first two weeks
used to detect HAV antigen (shed off in the intestine)
stool
px infected in first 2 wk (no Ab in serum)
viral Ag detected in stool is recommended
how long does early shedding of the virus in stool last?
first 15 days / 2 weeks
A marker of HAV infection:
It happens after 2nd week of infection; during onset of symptoms
Icterus/jaundice, inc liver enzyme levels
SGPT/ALT – liver specific
other liver enzymes may also increase (SGOT, nucleotidase)
IgM anti-HAV
IgM Ab starts to be produced in the serum/plasma
A marker of HAV infection:
during recovery phase
IgG anti-HAV and immunity development
detect the presence of specific HAV Abs
- ELISA
- RIA
true or false
INDIRECT ELISA DETECTS ANTIBODY
true
Indirect ELISA is used for detecting antibodies in a sample in order to quantify immune responses
true or false
DIRECT ELISA DETECTS ANTIGEN
true
what spx is used in direct elisa?
stool
Direct ELISA detects viral antigen
what marker is present in:
acute infection with HAV
IgM anti-HAV
what marker is present in:
Old infection (immune to HAV)
IgG anti-HAV
what marker is present in:
convalescence/recovery period in px with HAV
IgG anti-HAV
aka serum hepatitis
HBV
attacks the liver (hepatocytes) causing both acute and progress to chronic disease - more fatal and severe than HAV
HBV
Incubation period: 45-160 days (ave. 120 days)
HBV
MOT somewhat similar to HIV
HBV
MOT for this virus are the following:
o Direct contact with infectious blood, semen, and other body fluids primarily through:
– Birth to an infected mother
– Sexual contact with an infected person
– Sharing of contaminated needles, syringes, or other injection drug equipment
– Needle sticks or other sharp instrument injuries
HBV
what are the modes of transmission of HBV?
- HBV MOT: (somewhat similar to HIV)
o Direct contact with infectious blood, semen, and other body fluids primarily through:
– Birth to an infected mother
– Sexual contact with an infected person
– Sharing of contaminated needles, syringes, or other injection drug equipment
– Needle sticks or other sharp instrument injuries
the one and only DNA virus causing hepatitis
HBV
complete hepatitis B virion is called the _?
dane particle
replicate inside hepatocytes (liver cells)
Family: Hepadnaviridae
what are the six serologic markers of HBV?
- HBsAg
- HBcAg
- HBeAg
- Anti-HBs
- Anti-HBc
- Anti-HBe
a marker of HBV infection
previously known as the Australia antigen
HBsAg (hepatitis B surface antigen)
a marker of HBV infection
best indicator of early or acute hepatitis infection
HBsAg (hepatitis B surface antigen)
a marker of HBV infection
presence indicates active infection in either acute or chronic stage
HBsAg (hepatitis B surface antigen)
a marker of HBV infection
screened routinely; determines whether the patient requires vaccine or booster
HBsAg (hepatitis B surface antigen)
a marker of HBV infection
found within the core of intact virus
HBcAg (hepatitis B core antigen)
a marker of HBV infection
not detectable in serum; found only in hepatocytes (uncoats inside the cell/tissues)
HBcAg (hepatitis B core antigen)
a marker of HBV infection
specimen for detection: liver biopsy
HBcAg (hepatitis B core antigen)
a marker of HBV infection
NOT routinely tested in hepatitis profile
HBcAg (hepatitis B core antigen)
a marker of HBV infection
indicates chronic hepatitis
HBeAg (hepatitis B envelope antigen)
a reliable marker for the presence of high viral load, high degree of infectivity
HBeAg (hepatitis B envelope antigen)
first Ab to appear at the same time that liver enzyme elevations are first seen
Anti-HBc (anti-hepatitis B core)
a marker of HBV infection
found among asymptomatic carriers
Anti-HBc (anti-hepatitis B core)
only marker present during the WINDOW period
Anti-HBc (anti-hepatitis B core)
first serologic evidence of convalescence/recovery phase from hepatitis infection
Anti-HBe (anti-hepatitis B envelope)
may also indicate low level of virus; low degree of infectivity
Anti-HBe (anti-hepatitis B envelope)
bestows long-term immunity to further HBV infection
Anti-HBs (anti-hepatitis B surface)
measured several months after hepatitis B vaccination (assess vaccine effectiveness or if booster shot is needed)
Anti-HBs (anti-hepatitis B surface)
developed by a patient who had been infected to HBV or vaccinated
Anti-HBs (anti-hepatitis B surface)
confirms that the patient had past infection to HBV
Anti-HBc
Five possibilities:
* Resolved infection (most common)
* False-positive anti-HBc, thus susceptible
* “Low level” chronic infection
* Resolving acute infection
* Window/recovery period
Anti-HBc
what marker/s is/are present?
HBV chronic infection
- HBsAg
- Anti-HBc
- IgG anti-HBc
what marker/s is/are present?
HBV acute infection
- HBsAg
- anti-HBc
- IgM anti-HBc
what marker/s is/are present?
immunity due to HBV vaccination
Anti-HBs
what marker/s is/are present?
Immune due to natural infection (Past infection)
- Anti-HBc
- Anti-HBs
One way to improve immunity is __________. It promotes faster release and movement of lymphocytes in the blood. High levels produce sensitive and active immune response. Ab titer will remain in high levels for a long period.
exercise/physical activities
enumerate the tests for HBV detection
- 1st generation test - ouchterlony
- 2nd generation test
1. Counter Immunoelectrophoresis
2. rheophoresis
3. complement fixation - 3rd generation test
1. reverse passive latex agglutination
2. reverse passive hemagglutination
3. ELISA
4. RIA
HBV detection
1st generation test
ouchterlony
HBV detection
2nd generation test
- Counter Immunoelectrophoresis (CIE)
- Rheophoresis
- Complement Fixation
HBV detection
3rd generation test
- Reverse Passive Latex Agglutination
- Reverse Passive Hemagglutination
- ELISA
- RIA
what is the specific procedure of ouchterlony?
Specific procedure: double-diffusion double-dimension
ouchterlony specific procedure
HBV detection
Principle: Precipitation reaction
Specific procedure: double-diffusion double-dimension
1st generation test
ouchterlony
HBV detection
principle: precipitation with current
2nd generation test
counter immunoelectrophoresis
HBV detection
principle: precipitation by evaporation
2nd generation test
rheophoresis
HBV detection
Agglutination
Anti-HBsAg artificially/passively coated with latex particles (latex – carrier for anti-HBs to detect HBsAg)
detected: _
carrier: _
3rd generation test
reverse passive latex agglutination test
Detected: HBsAg
Carrier: latex
what is the most sensitive test in HBV detection?
3rd generation test (MOST SENSITIVE)
HBV detection
Principle: Hemagglutination
Anti-HBsAg passively attached to RBCs carrier to detect Ag
Carrier: __
3rd generation test
Reverse Passive Hemagglutination
HBV detection
commonly used test to confirm hepatitis B infection
3rd generation test
ELISA
true or false
Direct ELISA – detects HBsAg (hepa B antigen)
true
true or false
Indirect ELISA – detects Anti-HBs (hepa B antibody)
true
what HBV marker?
first to appear
HBsAg
hepatitis B surface antigen
what HBV marker?
signifies high viral load = px highly infectious
HBeAg
|hepatitis B envelope antigen
what HBV marker?
starts to peak as HBeAg levels decrease, since it signifies recovery; thus, low viral load.
Anti-HBe
anti-hepatitis B enveloope
Made by a recombinant strain of the yeast
Saccharomyces cerevisiae - common bakers’ yeast
HBV Vaccine (1982)
common baker’s yeast
Saccharomyces cerevisiae
HBV Vaccine (1982)
Made by a recombinant strain of the yeast
Enumerate disease states caused by HBV
- acute hepatitis
- fulminant hepatitis
- chronic
- co-infection with HDV
delta virus requires HBsAg for its replication
HBV and HDV simultaneously infect and replicate in hepatocytes
co-infection with HDV
asymptomatic carrier; chronic persistent hepatitis; chronic active hepatitis
chronic hepatitis
sudden, severe onset of a condition
fulminant hepatitis
starts with infection; progress to cancer if not managed
infectious cancer
a liver cancer, severe progression if HBV infection is not controlled
PRIMARY HEPATOCELLULAR CARCINOMA (HEPATOMA)
give the infectious type of cancer:
HBV
hepatoma
give the infectious type of cancer:
HPV
cervical cancer
give the infectious type of cancer:
EBV
nasopharyngeal cancer
dx hbv serologic test
no active infection, cured, long term immunity
Anti-HBsAg
dx hbv serologic test
active/on-going infection, either acute/chronic
HBsAg
dx hbv serologic test
not new nor old
both IgM & IgG anti-HBc
“Middle infection”
dx hbv serologic test
old infection, may persists for years
IgG Anti-HBcAg
dx hbv serologic test
new/early stage of infection
IgM Anti-HBcAg
true or false
HBcAg - antibodies; no antigen
true
core Ag not detected in serum, only found in liver intact cells/biopsy
true or false
core antigen is detected in serum
found in liver intact cells/biopsy and other tissues
false
core antigen not detected in serum, only found in liver intact cells/biopsy
dx hbv serologic test
low infectivity, low viral load
Anti-HBeAg
dx hbv serologic test
High infectivity, high viral load
HBeAg
true or false
In viral serology, antibody detection comes first before antigen appearance
false
In viral serology, Ag detection comes first before Abs appearance
true or false
Ag is responsible for stimulating the immune system to produce Ab
true
true or false
It is also impossible to detect only the antibody (i.e. HBcAg)
false
true or false
Delayed dx (asymptomatic patient) – antigen can be tested;
While antibody is recommended in early stages
false
true or false
HBV PREVENTION AND TREAMENT
* Serologic test on donor blood = HBsAg
* SGPT/ALT
* Active immunization
* Anti-viral agents for tx of chronic or persistent HBV infection – helps lower the viral load
* Anti-HBV drug Lamivudine
* Tx with interferon alpha (interferon therapy)
true
give the prevention and treatment for HBV infection.
- Serologic test on donor blood = HBsAg
- SGPT/ALT
- Active immunization
- Anti-viral agents for tx of chronic or persistent HBV infection – helps lower the viral load
- Anti-HBV drug Lamivudine
- Tx with interferon alpha (interferon therapy)
NON-A, NON-B HEPATITIS
HCV
Hepatitis C
Incubation period: 14-180 days (ave. 45 days)
HCV
aka blood-borne hepatitis, post-transfusion hepatitis
HCV
MOT: Commonly acquired thru blood transfusion
HCV
NO established vaccines, as it is a highly complex agent
HCV
true or false
HCV is a highly complex agent
true
no established vaccines
HCV AB REACTIVE
Presumptive HCV infection
Widespread infection in pregnant mothers (natural birthing process has high bleeding tendency; requires blood transfusion from increased blood loss)
HCV
HCV is an RNA virus from family __?
Single-stranded RNA virus
Family Flaviviridae
used to confirm HCV presence, a blood test that detects antibodies to the HCV
Recombinant ImmunoBlot Assay (RIBA)
SPECIALIZED TYPE OF METHOD - VIRAL CONFIMARTORY TESTING
HCV SPECIALIZED TYPE OF METHOD - VIRAL CONFIMARTORY TESTING
RIBA
Recombinant ImmunoBlot Assay
used to confirm HCV presence, a blood test that detects antibodies to the HCV
SEROLOGIC TESTS FOR HEPATITIS C
- Surrogate Testing for detecting NANBV/HCV in donated blood
- Serologic Tests for antibody against HCV Ag (Anti-HCV)
hcv serologic test
- ALT Level detection – markedly ↑ in hepatocyte destruction
- Anti-HBc detection – by RIA or ELISA using Enzyme Inhibition Technique
Surrogate Testing for detecting NANBV/HCV in donated blood
hcv serologic test
- ELISA
- RIA
Serologic Tests for antibody against HCV Ag (Anti-HCV)
markedly ↑ in hepatocyte destruction
ALT level detection
by RIA or ELISA using Enzyme Inhibition Technique
Anti-HBc detection
true or false
HCV antibody – for confirmatory
False
HCV antibody – for screening
true or false
HCV RNA – screening for reactive HCV Ab
false
HCV RNA – confirmatory for reactive HCV Ab
interpretation:
No HCV antibody detected
HCV antibody nonreactive
interpretation:
Presumptive HCV infection
HCV antibody reactive
interpretation:
Current HCV infection
Link to care
HCV antibody reactive, HCV RNA detected
interpretation:
No current HCV infection
Acquired past HCV infection due to reactive HCV Ab
Additional testing as appropriate
HCV antibody reactive, HCV RNA not detected
an RNA virus
MOT: parenteral (replicate only with the help of HBV)
HDV
Defective hepatotropic virus which requires obligatory helper functions from HBV in order to ensure its replication and infectivity
HDV
aka DELTA VIRUS
HDV
helical nucleocapsid actually uses HBV’s envelope, HBsAg (only replicates in cells infected with HBV)
HDV
Two infections carried out by HDV
Co-infection with HBV
Superinfection with HBV
px simultaneously becomes infected with both HBV and HDV
Co-infection with HBV
MOST SEVERE TYPE OF HEPATITIS in terms of fast rate of replication, infection, destruction to hepatocytes
Superinfection with HBV
px already chronically infected with HBV acquires HDV
Superinfection with HBV
a not very useful HDV serological marker
HDV Ag
a serological marker of HDV in the early stage of infection
HDV Ag
a serological marker of HDV that rapidly disappears in the plasma
HDV Ag
a serological marker of HDV in the acute phase of infection
IgM anti-HDV
total anti-HDV (IgM + IgG)
a serological marker of HDV signifying co-infection
IgM anti-HDV
IgM anti-HBc
HBsAg
a serological marker of HDV indicating HDV superinfection
IgM anti-HBc (-)
a serological marker of HDV indicating chronic infection
IgG anti-HDV (+)
rna virus, family calcivirus
HEV
rna virus, family calicivirus
HEV
HEV size
32-34 nm
HEV dx serology Ag & Ab
western blot
PCR
electron microscopy
HEV dx confirmatory
western blot
HEV dx that can be used in all types of agents
PCR
HEV dx with principle based on the detection of certain segments of the gene since all of these can be amplified
PCR
these patients with HEV may develop fulminant liver failure and death
pregnant women
true or false
there is a distinct serological marker for HEV, diagnosis based on symptoms for exposed individuals in endemic countries
false
NO distinct serological marker for HEV, diagnosis based on symptoms for exposed individuals in endemic countries
true or false
pregnant women with HEV may develop fulminant liver failure and death
true
an rna virus that has an envelope
same family as HCV - flaviviridae
HGV
MOT:
contact with blood, sexually transmitted, transplacental (mot almost the same with HIV & HCV)
HGV
an rna virus that is common worldwide but seems non-pathogenic
HGV
mild version of HCV
HGV
aka glandular fever
infectious mononucleosis
aka kissing disease
infectious mononucleosis
MOT:
exchange of mouth fluid / saliva during intense torrid kissing
infectious mononucleosis
most common during adolescence and early adulthood (15-25 y/o)
common in females
EBV infection
causative agent of infectious mononucleosis
EPSTEIN BARR VIRUS
true/false
EBV is common among males
false
DNA virus which infects B lymphocytes
EBV
may inhabit nasopharyngeal tissues without causing disease (asymptotic carriers)
EBV
enlarged lymphocytes affected by EBV with a characteristic atypical nuclei
downey cells or atypical T lymphocyte or reactive lymphocyte
symptoms that are called as IM-like symptoms
Symptoms during early stage of aids:
Fever, fatigue, sore throat, swollen lymph glands
IM classic symptoms which can also be found in the early stage of AIDS
fever
fatigue
sore throat
swollen lymph glands
used for any substance that stimulated the formation of sheep hemolysin (anti-sheep cells)
forssman antigen
antibodies produced by unrelated species, which can cross-react with the same antigen
used to dx IM
heterophil abs
Enumerate cells used to differentiate 3 abs
sheep cells
ox/beef cells
horse cells
guinea pig cells
What are the cells primarily useful in differentiation of IM antibodies?
guinea pig cells
ox/beef cells
heterophil abs in IM (not forssman in nature) are nonreactive to:
guinea pig cells
heterophil abs in IM (not forssman in nature) are reactive to:
sheep cells
ox cells
horse cells
heterophil abs of forssman are nonreactive to:
ox cells
heterophil abs of forssman are reactive to:
sheep cells
horse cells
guinea pig cells
heterophil abs in serum sickness are nonreactive to:
none
heterophil abs in serum sickness are reactive to:
all 4 cells
- sheep
- horse
- ox
- guinea pig
abs can be used as control since its positive in all 4 cells
what are the tests for IM heterophil antibodies?
- paul bunnel test
- davidson differential test
- monospot
- rapid differential slide test using papain-treated sheep rbcs
PRINCIPLE OF:
DAVIDSON DIFFERENTIAL TEST
Absorption-hemagglutination
PRINCIPLE OF:
PAUL BUNNEL TEST
hemagglutination
Presumptive/screening test for heterophil Ab presence
paul bunnel test
Incapable of determining specificity of heterophil Abs; only indicative of presence or absence of heterophil Abs – requires further testing to determine specific Ab
paul bunnel test
Paul Bunnel Test
reagent ag
2% suspension of sheep RBCs
paul bunnel test
antibody
heterophil Abs in px serum
paul bunnel test
Detected Abs
IM, forssman, serum sickness Abs
paul bunnel test
(+) result
hemagglutination (heterophil Abs presence)
Determine specific Ab that reports (+) in Paul Bunnel test
DAVIDSON DIFFERENTIAL TEST
2 steps of davidson differential test
- absorption
- hemagglutination
davidson differential test
exposure of test serum to both beef cells and guinea pig cell which causes absorption of either one or both of these antibodies
absorption
davidson differential test
indicator cells
sheep rbcs
davidson differential test
Ag
guinea pig kidney cells
beef RBCs
davidson differential test
Ab
heterophil Abs in px serum (same sample used in paul bunnel test)
davidson differential test
“absorbed agglutinins” (precipitates) are removed by centrifugation; resultant fluid (supernatant) are then tested with sheep RBC
hemagglutination
true or false
If the absorption is positive in step 1, antibody titer decreases. Hence, agglutination in step 2 weakens.
true
true or false
If the absorption is negative in step 1, antibody titer is retained low. Hence, agglutination in step 2 is strong.
false
If the absorption is negative in step 1, antibody titer is retained high. Hence, agglutination in step 2 is strong.
PRINCIPLE
MONOSPOT
Absorption-hemagglutination
SAME PATTERNS WITH DAVIDSON.
monospot
monospot Ag
Guinea Pig Kidney cells
Beef RBC
monospot Ab
Heterophil Abs in px’s serum
monospot indicator cells
horse cells
PRINCIPLE OF:
RAPID DIFFERENTIAL SLIDE TEST using Papain-Treated Sheep RBCs
hemagglutination
Papain + sheep cells = ?
receptors for Abs are specifically INACTIVATED
Causative agent of HIV infection
Family: Retroviridae
Subfamily: Lentivirus and Oncovirus
HIV
Has a marked preference for T-helper/inducer lymphocytes (CD4+) which serves as the target cell of the HIV
HIV
Higher rate of transmission making it a predominant type of HIV
HIV-1
Majority occurred in West Africa, less pathogenic, lower rate of transmission
HIV-2
HIV formerly called as
1. .
2. .
3. .
Formerly called:
1. Human T-cell lymphotrophic virus-type III (HTLV-III)
2. Lymphadenopathy associated virus (LAV)
3. AIDS-associated retrovirus (ARV)
Destruction on CD4 lymphocytes – will allow opportunistic infections and malignancies
secondary effects of HIV
gene & viral gene products
Codes for core structural (group Ags) proteins
gag
p24, p18, p15
absorption pattern of beef rbcs in forssman
-
absorption pattern of gpkc in forssman
+
absorption pattern of beef rbcs in IM
+
absorption pattern of gpkc in IM
-
agglutination pattern of beef rbcs in forssman
++++
agglutination pattern of gpkc in forssman
+
agglutination pattern of beef rbcs in IM
+
agglutination pattern of gpkc in IM
++++
true or false
normal serum & IM serum has weak or no agglutination in papain-treated sheep rbcs
true
target cell of HIV
T-helper/inducer cells
CD4+ cells
transcribes ssrna into dsdna
reverse transcriptase
(which is a pol)
true or false
If screening tests for HIV antibody is reactive, confirmatory tests is performed to rule out false positives.
true
If screening tests for HIV antibody is nonreactive but patient is at high risk for HIV infection , re-testing using ELISA may be done after how many months?
3 to 6 months
most widely used HIV test for screening
Indirect ELISA
follow up with ELISA to rule out false positives
false
follow up with western blot
principle:
Tests kits for screening
Lateral flow chromatography
what are the 3 bands that must appear?
p24, gp41, g120/160
what is considered as HIV positive for western blot assay?
(+) result: presence of 2 out of 3 major bands
a confirmatory test, used to detect HIV infected cells
*western blot is more frequently used
Indirect immunofluorescence assay (IFA)
list the criteria for dx of aids
- positive for HIV
- CD4 count fewer than 200 cells/ml
- CD4 cells account fewer than 14% of all lymphocytes
- experience one or more of a CDC-provided list of AIDS-defining illnesses
- 2-10 years after initial infection
- A syndrome of CD4 depletion resulting in opportunistic infections and cancers suggestive of cell-mediated immunity defects
- Fungal infections = Immunodeficiency or severely depleted immune state
final stage
normal ratio of CD4:CD8
2:1
CD4:CD8 intermediate stage ratio
0.5 : 1
State known as the ARC (Aids-Related Complex)
intermediate stage
- Patient is either asymptomatic or may show mild lymphadenopathy
- Resembles IM (Infectious Mononucleosis)
primary stage
opportunistic pathogens
- Pneumocystis carinii, now known as Pneumocystis jeruveci
- Mycobacterium avium-intracellulare complex
- Candida albicans
- Cryptosporidium parvum
- Toxoplasma gondii
- Cryptococcus neoformans
- Herpes Simplex (I and II)
- Legionella spp.
- Tumors in skin and linings of internal organs, lymphomas, and cancers of rectum and lung
kaposi’s sarcoma
causative agent of kaposi’s sarcoma
human Herpes simplex virus type 8
caused by human Herpes simplex virus type 8
kaposi’s sarcoma
caused by HSV type 8
Most frequent malignancy observed
kaposi’s sarcoma
first antibody to be detected persist throughout the infection of kaposi’s sarcoma
anti-gp41
In the Philippines, a new confirmatory procedure is being implemented to replace Western blot assay.
rHIVda
Rapid HIV diagnostic algorithm
In rHIVda, px reported as inconclusive is advised to retest after _ ?
2 to 6 weeks
if tested negative for rHIVda, px sample must be sent to this lab for possible western blot examination
NRL-SLH
what is nonreactive to:
heterophile antibody in IM
guinea pig cells
what is nonreactive to:
forssman
ox cells
what is nonreactive to:
serum sickness
none
what is reactive to:
serum sickness
all 4 cells:
1. ox / beef cells
2. horse cells
3. guinea pig cells
4. sheep cells
An anti-HBV drug
Lamivudine
This infection uses interferon therapy
HBV infection
*tx with interferon alpha
