L76 (Hep C, A, E)

Question 1

Hep C genome

Answer 1

+ ss RNA
LARGE
Genotypes 1-7

Question 2

What are the 3 Hep C drug targets?

Answer 2

Non-structural proteins - disable these, disable viral fxn
NS -34A = Protease
NS-5B = RNA pol
NS-5A = critical for viral replication

Question 3

Hep C transmission

Answer 3

Blood - IVDU!!!
Sex
Perinatal

Question 4

Hep C receptor on liver cells

Answer 4

CD81

Shows liver tropism

Question 5

Where does Hep C replicate in host cells?

Answer 5

Cytoplasm - ER

Question 6

Can Hep C go chronic?

Answer 6

Yepppp

Cirrhosis or cancer

Question 7

Most common US genotype

Answer 7

1a

Question 8

Diagnose Hep C

Answer 8

1. ELISA for Ab - more a rule out test
   Follow up with
2. PCR for RNA (viral load)

Question 9

Which is more likely to resolve in acute on own: Hep C or B?

Answer 9

B more likely to resolve as acute

C - chronic

Question 10

What is the difference between Hep C and B cancer risk?

Answer 10

C chronic more stable

B you’re worried about a switch flip to cancer

Question 11

Who do you treat for Hep C

Answer 11

Fibrosis stage 2+

Need to make sure will be treatment compliant

Question 12

Treat Hep C

Answer 12

A CURE!!!
DAAs = direct acting anti-virals = target non-structural genes
2 DAA = 
- Harvoni
- Veikira

Question 13

Hep C grade vs stage

Answer 13

Determined by biopsy
Grade = amt liver inflam
Stage = amt of fibrosis

Question 14

Hep C treatment issues

Answer 14

$$$
Resistance
- Fail NS5A regimen, don’t have great alternatives

Question 15

What is unique about genotype 3 treatment?

Answer 15

Doesn’t respond great to DAAs

Better on IFN, but we don’t use this anymore due to toxicities

Question 16

Define Hep C cured

Answer 16

No viral load for 3-6 mos

Question 17

Why can’t you cure HIV or Hep B?

Answer 17

B/c genetic elements persist in the nucleus
HIV - integrates into host DNA
HBV - cccDNA

Question 18

What is Harvoni

Answer 18

Ledipasvir + Sofosbuvir
Ledi = X NS5A (critical for rep)
Sofo = X RNA pol

Question 19

What is Veikira

Answer 19

Protease inhibitor +
NS5A inhibitor +
Non-nucleoside NS5B inhibitor

Question 20

Hep A genome

Answer 20

+ssRNA

Picorna - acute viral hepatitis

Question 21

Hep A transmission

Answer 21

Food/water contaminated by feces (Seafood)
Oral –> GI –> blood –> liver
Replicates in liver –> released in bile = infectious feces

Question 22

Can Hep A go chronic?

Answer 22

Nope

Question 23

Treat Hep A

Answer 23

Supportive

Question 24

Hep A vaccine

Answer 24

1. Passive IG - travelers

2. Active vaccine

Question 25

Hep E genome

Answer 25

+ssRNA

Naked

Question 26

Hep E genotypes

Answer 26

1 & 2 = human host

3 & 4 = pig host, human accident

Question 27

Who are you worried about getting a genotype 1 or 2 Hep E infection? Transmission.

Answer 27

Will infect pregnant women!!!
- HIGH mortality :(
Fecal-oral/water transmission

Question 28

Unique characteristics of Hep E genotypes 3 & 4

Answer 28

Food borne (pork)
Neuro complications

Question 29

Treat Hep E

Answer 29

Supportive

Question 30

Which hep strains can cause fulimnant liver failure?

Answer 30

A
B
E in pregnant women

Question 31

Which hep strains can become chronic?

Answer 31

C !!!
B - newborns
E - transplant pts

Question 32

Which hep strains will resolve?

Answer 32

A
E
Most B
Some C - likely not

Question 33

Which hep strains have active and passive vaccines?

Answer 33

A

B

Question 34

Which hep strains do you treat with anti-virals?

Answer 34

B

C