L76 (Hep C, A, E) Flashcards
Hep C genome
+ ss RNA
LARGE
Genotypes 1-7
What are the 3 Hep C drug targets?
Non-structural proteins - disable these, disable viral fxn
NS -34A = Protease
NS-5B = RNA pol
NS-5A = critical for viral replication
Hep C transmission
Blood - IVDU!!!
Sex
Perinatal
Hep C receptor on liver cells
CD81
Shows liver tropism
Where does Hep C replicate in host cells?
Cytoplasm - ER
Can Hep C go chronic?
Yepppp
Cirrhosis or cancer
Most common US genotype
1a
Diagnose Hep C
- ELISA for Ab - more a rule out test
Follow up with - PCR for RNA (viral load)
Which is more likely to resolve in acute on own: Hep C or B?
B more likely to resolve as acute
C - chronic
What is the difference between Hep C and B cancer risk?
C chronic more stable
B you’re worried about a switch flip to cancer
Who do you treat for Hep C
Fibrosis stage 2+
Need to make sure will be treatment compliant
Treat Hep C
A CURE!!! DAAs = direct acting anti-virals = target non-structural genes 2 DAA = - Harvoni - Veikira
Hep C grade vs stage
Determined by biopsy
Grade = amt liver inflam
Stage = amt of fibrosis
Hep C treatment issues
$$$
Resistance
- Fail NS5A regimen, don’t have great alternatives
What is unique about genotype 3 treatment?
Doesn’t respond great to DAAs
Better on IFN, but we don’t use this anymore due to toxicities
Define Hep C cured
No viral load for 3-6 mos
Why can’t you cure HIV or Hep B?
B/c genetic elements persist in the nucleus
HIV - integrates into host DNA
HBV - cccDNA
What is Harvoni
Ledipasvir + Sofosbuvir
Ledi = X NS5A (critical for rep)
Sofo = X RNA pol
What is Veikira
Protease inhibitor +
NS5A inhibitor +
Non-nucleoside NS5B inhibitor
Hep A genome
+ssRNA
Picorna - acute viral hepatitis
Hep A transmission
Food/water contaminated by feces (Seafood)
Oral –> GI –> blood –> liver
Replicates in liver –> released in bile = infectious feces
Can Hep A go chronic?
Nope
Treat Hep A
Supportive
Hep A vaccine
- Passive IG - travelers
2. Active vaccine
Hep E genome
+ssRNA
Naked
Hep E genotypes
1 & 2 = human host
3 & 4 = pig host, human accident
Who are you worried about getting a genotype 1 or 2 Hep E infection? Transmission.
Will infect pregnant women!!!
- HIGH mortality :(
Fecal-oral/water transmission
Unique characteristics of Hep E genotypes 3 & 4
Food borne (pork) Neuro complications
Treat Hep E
Supportive
Which hep strains can cause fulimnant liver failure?
A
B
E in pregnant women
Which hep strains can become chronic?
C !!!
B - newborns
E - transplant pts
Which hep strains will resolve?
A
E
Most B
Some C - likely not
Which hep strains have active and passive vaccines?
A
B
Which hep strains do you treat with anti-virals?
B
C
