Infection 6) Viral hepatitis

Question 1

Describe histological stage 1 of hepatic fibrosis

Answer 1

Fibrous expansion of some portal areas

Question 2

Describe histological stage 3 of hepatic fibrosis

Answer 2

Fibrous expansion of most portal areas with occasional portal to portal bridging

Question 3

Describe histological stage 4 of hepatic fibrosis

Answer 3

Fibrous expansion of portal areas with marker bridging

Question 4

What areas of the world have high prevalence of hepatitis B?

Answer 4

Canada
Africa
China
India

Question 5

What are the risk factors for hepatitis B?

Answer 5

Ethnicity
IVDU
MSM
HIV
Health care worker

Question 6

Describe the immunology of hepatitis B

Answer 6

PAMP recognised by TLR3 leading to RIG-1 signalling. Interferon regulatory factors and NF-kB
Interferon stimulating genes
INF - alpha/beta
Downregulation of viral protein synthesis, inhibit viral replication, promote adaptive immunity via MHC class I expression on APC
Activates NK, CD8 and dendritic cells
Activate cell death through secretions of perforins

Question 7

What leads to a persistent infection of hepatitis B?

Answer 7

Age at infection
Immunosuppression 
HBV X protein 
Foxp3
Programmed death-1 receptor up-regulated
Cytotoxic T-lymphocyte antigen 4
IL-10

Question 8

What does IL-10 do?

Answer 8

Downregulates antiviral immune responses

Attenuates inflammatory response but reduces efficiency of antiviral immune responses

Question 9

What is the treatment for chronic hepatitis 6?

Answer 9

Pegylated interferon
Tenofovir / tenofovir alafenamide
Entecavir

Question 10

What are some mutations in the Pre-S/S HBV region?

Answer 10

Pre-S1/pre-S2
S promoter
S
S splicing

Question 11

What % develop chronic hepatitis C virus?

Answer 11

80%

Question 12

Why does hepatitis C have a high rate of chronicity?

Answer 12

High replicative rate and viral antigen load
High error rate of RNA-dependent RNA polymerase
HCV proteins interfere with immune response
Neutralising antibodies develop too slowly, too late