Lecture 22 - Medical Mgmt of Viral Hepatitis

Question 1

Hepatitis is considered acute if it lasts for < _____. Chronic is longer than that.

Answer 1

acute < 6 months

Question 2

Hep A is transmitted via _____-_____ route.

Does Hep A cause Chronic infection?

Answer 2

Fecal-oral

No

Question 3

Hep B is _____ borne, but it is considered ______ transmitted.

Does Hep B cause Chronic infection?

Answer 3

Blood borne

Sexually transmitted

Yes

Question 4

Hep C is _____ borne, and it is only very RARELY transmitted Sexually.

Can Hep C cause Chronic infection?

Answer 4

Blood borne

Yes

Question 5

Hep D is _____ borne, and infection with Hep D occurs with Hep ____.

Does Hep D cause Chronic infection?

Answer 5

Blood borne

Hep B

Yes

Question 6

Hep E is transmitted like Hep A, so what is the route?

It is mostly found in Asian countries –> best mode of prevention?

Does Hep E cause Chronic infection?

Answer 6

Fecal-oral

Ensure safe drinking water.

No

Question 7

Where in the US does Hep A mostly occur?

Answer 7

West Coast

Question 8

The incubation phase for Hep A averages _____ days (ranging between 15-50).

Answer 8

30

Question 9

Children under ____ years old are typically Asymptomatic with Hep A infection.

About half of children ___-___ years old will be asymptomatic.

Adults and Children over ____ years old will mostly (about 70-80%) be symptomatic.

Answer 9

6

6-14

14

Question 10

People with possible exposure should be vaccinated for Hep A within ____ days of suspected exposure.

Answer 10

14 days

Question 11

How long does passive immunity (treatment with antibodies) last?

Answer 11

About three months

Question 12

Hep B is most prevalent in ______ and ______.

Answer 12

Africa and Asia

Question 13

HBeAg is an indicator of viral ______. If Surface Antigen is present, that means there is ______ (current or previous?) infection.

Initially, patients will create Anti-HB-_____ Igs. As the viral load decreases over the course of infection, patients may produce Anti-HB____ Igs, which are considered CURATIVE.

Answer 13

Replication

Current

Anti-HBc

Anti-HBs (surface protein)

Question 14

How does age relate to likelihood of developing chronic HBV?

Answer 14

Neonates > infants > children > adults

90% vertical transmission from pregnant mom to newborn without vaccine!

Question 15

Of the Hepatitis viruses, which one can cause liver cancer without first progressing to cirrhosis?

Answer 15

HBV

Question 16

Patients that have Anti-HBs Igs WITHOUT Anti-HBc Igs have been ______ (vaccinated or infected?)

Answer 16

Vaccinated

Question 17

Infants born to mothers with active infection, as determined by presence of _______ in their blood, should receive HBV vaccine + _________.

Answer 17

HBs antigen

Vaccine + HB Ig (to generate active AND passive immunity)

Question 18

Patients infected with HBV are typically not treated until they meet the following 3 criteria:

1. Chronic HBV infection as determined by positive test for _____ antigen for more than 6 months.
2. Evidence of high viral load/replication as determined by serum HBV DNA > ______IU/mL for _____ positive patients or HBV DNA > _____IU/mL for _____ negative patients.
3. Evidence of _____ damage as determined by elevated _____ and/or evidence of chronic hepatitis on biopsy (chronic inflammatory cells! so NOT neutrophils).

Answer 18

1. HBs Antigen (HBsAG)
2. HBV DNA > 20,000 IU/mL for HBeAG + patients OR > 2,000 IU/mL for HBeAG - patients.
3. Liver damage

ALT

Question 19

Because it occurs with concomitant infection with HBV, HDV will result in chronic hepatitis in about ____% of patients.

Answer 19

90%

Question 20

What is the common treatment for HDV and HBV?

Answer 20

Interferon (pegylated for HDV)

Question 21

The average incubation for HEV is about ____ days (longer than the other Hepatitis viruses).

For which demographic is HEV deadliest?

Though HEV doesn’t typically cause chronic infection, who is at risk for this?

Answer 21

40 days

Pregnant women

Immunocompromised

Question 22

Patients born between _____ and _____ MUST be tested for HCV.

Answer 22

1945 and 1965

Question 23

About 70% of HCV patients will progress to ______ hepatitis. Keep in mind HCV is unique in that patients who test positive for Abs do not have ______, instead they have ______.

Answer 23

Chronic hepatitis

Immunity

Infection

Question 24

People who had blood transfusions or organ transplants before ____ are at higher risk for HCV.

Answer 24

1992

Question 25

What is the most common type of HCV in the United States?

Answer 25

Type 1

Question 26

Progression of HCV to cirrhosis depends on a few factors: Duration of infection, Alcohol consumption > ____gm/day, Age > _____, _____ gender.

Answer 26

50gm

40 years

Male gender

Question 27

NS3/4, NS5B, and NS5A are all antiviral therapies for HCV treatment. How do they each work?

Answer 27

They all prevent replication of the virus (so it’s already INTRAcellular).

NS3/4 is a protease inhibitor.

NS5B is an RNA pol inhibitor.

NS5A is protein inhibitor.