L75 (Hep B & D)

Question 1

What does elevated AST/ALT indicate vs elevated bilirubin?

Answer 1

AST/ALT: liver injury

Bilirubin: liver dysfxn

Question 2

Hep B
DNA or DNA?
Envelope?

Answer 2

SMALL
DNA - partially ds
Envelope

Question 3

Important Hep B antigen proteins

Answer 3

Surface antigens
Core antigen
e antigen

Question 4

Role of e antigen

Answer 4

Unknown
May buffer virus from immune response
USED as marker of viral replication

Question 5

How is Hep B transmitted?

Answer 5

Blood = high [ ]
- Also wound exudates
Sexual = moderate [ ]
Peri-natal

Question 6

Once Hep B gets to the liver via blood, how does it enter hepatocytes?

Answer 6

You don’t know this

Question 7

Where does Hep B replicate in hepatocytes?

Answer 7

Nucleus

partially dsDNA -> RNA -> totally dsDNA = cccDNA

Question 8

Because Hep B is so small, how does it manipulate its genome to create the various proteins it needs?

Answer 8

Overlapping reading frames

Question 9

What enzyme does Hep B carry?

Answer 9

RT

Duh! B/c it’s a DNA virus!!

Question 10

What is a common theme throughout hepatitis?

Answer 10

Immune response to the virus = 1ary liver damage

- T cells

Question 11

What Ab shows acute Hep B infection? Chronic?

Answer 11

Acute = IgM
Chronic = IgG
DUH! Immunology 101!!!

Question 12

What will you see on serology for acute Hep B?

Answer 12

Viral load - antigens & DNA only

Not enough time to create Ab response

Question 13

Serology for resolved Hep B + other signs?

Answer 13

Surface antigen Ab
Core Ab
Both IgG
cccDNA !!! not in serum but permanently in cells!

Question 14

Serology for chronic Hep B

Answer 14

Surface antigen present for 6mo
\+/- e antigen 
IgG core Abs
DNA 
NO surface Ab!!! Weird

Question 15

Progression of undiagnosed/treated Hep B

Answer 15

Fibrosis -> cirrhosis -> liver failure

Cancer!!!

Question 16

Will most Hep B infected kids progress to chronic infection or not?

Answer 16

YES

Over 90%

Question 17

Will most normal pts infected with Hep B progress to chronic infection or not?

Answer 17

NO
Less than 5%
Resolved: no additional surveillance

Question 18

What is the difference between chronic hepatitis with or without e antigen?

Answer 18

+ e antigen = MUCH higher viral load

Question 19

Who/why do you treat chronic Hep B?

Answer 19

Who:
- High viral load
- Active liver disease
Why: prevent progression

Question 20

Treat Hep B

Answer 20

Prolonged course:
- Entecavir OR tenofovir
+ PegIFN

Question 21

2 ways to prevent Hep B

Answer 21

1. Passive immunity = Hep B IG
   - Temporary
   - Post-exposure
   - Babies of infected moms
   - Within 24hrs, ineffective 7 days later
2. Vaccine

Question 22

Hep D requires…

Answer 22

Hep B for infection!!1

Question 23

Hep D transmission

Answer 23

IVDU

Question 24

2 types of Hep D infection

Answer 24

1. Coninfection w/ B

2. Superinfection

Question 25

Hep D structure

Answer 25

ssRNA –> codes for delta antigen

Hep B membrane!!!

Question 26

Diagnose presence of Hep D

Answer 26

Ab in serum

RNA by PCR

Question 27

Treat Hep D

Answer 27

Peg-IFN

Nucleos/tide analogues = INEFFECTIVE