Lecture 22 - Medical Mgmt of Viral Hepatitis Flashcards
Hepatitis is considered acute if it lasts for < _____. Chronic is longer than that.
acute < 6 months
Hep A is transmitted via _____-_____ route.
Does Hep A cause Chronic infection?
Fecal-oral
No
Hep B is _____ borne, but it is considered ______ transmitted.
Does Hep B cause Chronic infection?
Blood borne
Sexually transmitted
Yes
Hep C is _____ borne, and it is only very RARELY transmitted Sexually.
Can Hep C cause Chronic infection?
Blood borne
Yes
Hep D is _____ borne, and infection with Hep D occurs with Hep ____.
Does Hep D cause Chronic infection?
Blood borne
Hep B
Yes
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?
Fecal-oral
Ensure safe drinking water.
No
Where in the US does Hep A mostly occur?
West Coast
The incubation phase for Hep A averages _____ days (ranging between 15-50).
30
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.
6
6-14
14
People with possible exposure should be vaccinated for Hep A within ____ days of suspected exposure.
14 days
How long does passive immunity (treatment with antibodies) last?
About three months
Hep B is most prevalent in ______ and ______.
Africa and Asia
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.
Replication
Current
Anti-HBc
Anti-HBs (surface protein)
How does age relate to likelihood of developing chronic HBV?
Neonates > infants > children > adults
90% vertical transmission from pregnant mom to newborn without vaccine!
Of the Hepatitis viruses, which one can cause liver cancer without first progressing to cirrhosis?
HBV
Patients that have Anti-HBs Igs WITHOUT Anti-HBc Igs have been ______ (vaccinated or infected?)
Vaccinated
Infants born to mothers with active infection, as determined by presence of _______ in their blood, should receive HBV vaccine + _________.
HBs antigen
Vaccine + HB Ig (to generate active AND passive immunity)
Patients infected with HBV are typically not treated until they meet the following 3 criteria:
- Chronic HBV infection as determined by positive test for _____ antigen for more than 6 months.
- 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.
- Evidence of _____ damage as determined by elevated _____ and/or evidence of chronic hepatitis on biopsy (chronic inflammatory cells! so NOT neutrophils).
- HBs Antigen (HBsAG)
- HBV DNA > 20,000 IU/mL for HBeAG + patients OR > 2,000 IU/mL for HBeAG - patients.
- Liver damage
ALT
Because it occurs with concomitant infection with HBV, HDV will result in chronic hepatitis in about ____% of patients.
90%
What is the common treatment for HDV and HBV?
Interferon (pegylated for HDV)
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?
40 days
Pregnant women
Immunocompromised
Patients born between _____ and _____ MUST be tested for HCV.
1945 and 1965
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 ______.
Chronic hepatitis
Immunity
Infection
People who had blood transfusions or organ transplants before ____ are at higher risk for HCV.
1992
What is the most common type of HCV in the United States?
Type 1
Progression of HCV to cirrhosis depends on a few factors: Duration of infection, Alcohol consumption > ____gm/day, Age > _____, _____ gender.
50gm
40 years
Male gender
NS3/4, NS5B, and NS5A are all antiviral therapies for HCV treatment. How do they each work?
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.
