Viral hepatitis Flashcards
chronic persistent hepatitis
- lymphocytic infiltration maintained within the portal triad
chronic active hepatitis
- lymphocytic infiltration which spreads into the lobule
treatment of HAV
- HAV vaccine + globulin within 2 weeks of exposure
- prophylaxis: HAV vaccine + globulin
diagnosis of HAV
- HAV IgM
- HAV IgG: infection has cleared, confers immunity
HBV DNA
- denotes viremia
- >10,000 denotes active disease
treatment of chronic stable HBV
- entecavir is a new protease inhibitor with good results and little to no resistance
- pegylated interferon used for 4 months as a weekly injection has the highest percentage of seroconversion
SE of adefovir
- occasionally can cause nephrotoxicity
if pregnant woman is HBsAg positive
- child needs immune globulin and vaccine at birth
- C-section is not helpful
goals of treatment
- conversion of HBeAg to HBeAb positivity
- loss of HBV DNA in blood
- long term conversion of HBsAg to HBsAb
- slow progression to cirrhosis or HCC
surveillance program for HBV
- sonogram and a-fetoprotein q 6 months
NIH definition of chronic HBV
- HBsAg positive for more than 6 months
- HBV DNA >105
- persistent or intermittent ALT/AST elevation
- liver biopsy showing chronic hepatitis
NIH definition of inactive HBsAg carrier
- HBsAg positive for more than 6 months
- HBeAg negative, HBeAb positive
- persistently normal ALT/AST
- liver biopsy showing no inflammation
NIH definition of resolved
- previously known history of hep B
- HBcAb positive or HBsAb positive
- undetectable HBV DNA
- normal ALT
treatment of acute HDV
- supportive
treatment of fulminant HDV
- liver transplant
treatment of chronic HDV
- interferon
hepatitis E
- 20% fatality in pregnancy
associations with hep C
- porphyria cutanea tarda
- cirrhosis is necessary for HCC unlike with HBV
testing for HCV
- ELISA II - sensitive but not specific
- RIBA II - confirmatory tests
criteria for HCV treatment
- positive HCV RNA
- positive liver biopsy for chronic infection
- no significant psychiatric disease, blood dyscrasias, ongoing alcohol or drug abuse
treatment of HCV
- IFN, ribavirin, protease inhibitors
- pegylated IFN with ribavarin: 61% cure
interferon
- interaction with cell surface receptors
- WORSENS PSYCH - dont use with depression and other psych disorders
- increased cytotoxic activity of NK cells
ribavirin
- may cause hemolysis
- teratogenic: use 2 kinds of BC while on this
protease inhibitors
- telaprevir and boceprivir increase rate of clearance when used with PEG interferon and ribavirin
type 1 HCV
- treat for 12 months
CMV hepatitis
- owls eye inclusions
- TX: gancyclovir
herpes hepatitis
- giant cell granulomas
- cause fulminant hepatic failure
- usually occurs in 3rd trimester of pregnancy in those with genital herpes
- Tx: acyclovir
