Viral Hepatitis Flashcards
which hepatitis virus is DNA genome
B
hep ___ causes chronic hepatitis in 10%, whiel hep ___ causes it in 70%
B, C
hepatitis A is _______ (enveloped/ nonenv), _____ (RNA?DNA) virus
nonenveloped
RNA
Hep A transmission is through
fecal oral
ingestion of contaminated food or water
immune response by ________ likely cause of hepatocyte damage in Hep A
cytotoxic T cells
which of the following is false regarding hep A
1. children are often asymptomatic
2. virus replicates outside of hepatocytes, causing generalized inflammation
3. serology of negative anti-HAV IgM and + AntiHAV-IgG = immunity from past infection or vaccine
4. all of the above are true
2
what does + anti HAV IgM and IgG mean
acute or recent HAV infection
list 3 ways to prevent hep A infection
Hand washing + contact precautions
Sanitation, Avoid drinking contaminated water
Boil food/ beverages that may be contaminated
Hep A vaccination, Immunoglobulin
hep A is generally
1. self limiting
2. requires hospitalization
3. requires immunization if recent infection
4. none of the above
1
hep B is a ___ (RNA/ DNA) virus that is ___ (enveloped/ nonenveloped)
DNA
enveloped
HBsAG is on the
outer surface
HBcAG and HBeAG is the
inner core
labs expected to see in No current/ previous HBV infxn
No immunity
negative to HBsAG, antiHBs, antiHBc
labs expected to see in HBV immunity due to vaccination
neg HBsAG, antiHBc
+ antiHBs
labs expected to see in chronic HBV infection
+HBsAG, - antiHBs, + antiHBc
T or F: hep B is curable
F
how to prevent Hep B
vaccination
passive immunity in post exposure individuals
barrier protection + avoid sharing products which may have blood
hep C disproportionately affects
indigenous
IJDUs
immigrants
homeless or incarcerated
born 1946-1965
list 3 ways hep C can be transmitted
Sharing drug injection equipment
Unsterile tattooing or body piercing
Unsterile medical or dental procedures (where skin is pierced)
Blood produce transfusion in Canada before 1992
Parent to child transmission during pregnancy or childbirth (do not need to avoid pregnancy or breastfeeding)
Sexual transmission (even trace blood)
Reusing someone’s personal items with blood on them (ex- razors, nail clippers, toothbrushes)
rank the following from lowest to highest risk of transmission by needlestick: HIV, HCV, HBV
HIV < HCV <HBV
initial clinical presentation of hep C is usually ______
asymptomatic
HCV is detectable within ____ and ____ increases
1-2wks
ALT
hep C sx
Fatigue, weakness
Anorexia, abdominal pain
Jaundice, dark urine
describe prognosis of untx hep C infection
15-40% resolution
60-80% chronic HCV → 20% cirrhosis @ 20yrs (death/ transplant) → 1-4% hepatocellular carcinoma @ 30 yrs (death/ transplant)
what is a way to prevent hep C transmission by up to 80%
Access to opioid agonist tx + needle and syringe programs (NSP) can reduce HCV by up to 80%
T or F: dried hep C blood is not contagious
F- is contagious,. should clean with bleach
list 3 populations we should test for HCV
Current/ hx IJDU
Born or had medical/ dental tx in HCV endemic countries
Received healthcare where there is a lack of universal precautions
Received blood transfusions, products, or organ transplant in Canada before 1992>18mths born to mothers with HCV
Hx incarceration
Hx needle stick injury
Persistently elevated ALT
Other RF: high risk sexual behavior, homelessness, IN drug use, tattooing, body piercing, sharing personal care items with someone who is HCV infxn
hep C virus should be tested ____ after exposure for ____
3mths
RNA
if antibodies for HCV are positive, that indicates
acute, chronic, or past infxn
if a PCR HCV RNA is +, what happens
confirm using RNA
if RNA - = HCV cleared (past infxn)
if RNA + = current infxn
pros of POCT hep C
Easy to perform (capillary blood - finger prick)
Results in 20min
V good sensitivity and spec (96-100%, 99-100%)
Easy to adapt to diff practice models/settings
Low barrier for testing
cons of POCT hep C
Requires confirmation (HCV RNA)
Results not on netcare
Pt may be at risk of HIV or other STIs
Cost of testing
pros of dried blood spot hep C test
Easy to perform (capillary blood - finger prick)
V good sensitivity and spec
Can detect HCV RNA
Can test for multiple infections (HIV, HBV, syphilis, etc)
Low barrier for testing
cons of hep C blood spot test
Not widely available at public health labs
Results not immediate
T or F: hep C is a notifiable disease in alberta
T
what are some counselling tips for adults with HCV infection
reduce/ avoid alcohol
Smoking cessation (to ↓ risk hepatocellular carcinoma)
Hep A and B vaccines (if nonimmune)
Maintain healthy weight and diet
avoid/ limit hepatotoxic agents/ drugs
list 10 labs to order in HCV infection
anti-hep A
IgG antibody
hep B surface antigen
anti-Hbc antibody
anti-HBs antibody
AST
ALT
CBC
creatinine
if FIB-4 >3.25 =
refer to specialist
tx for hep C is recommended for
all pts with chronic HCV infection
who do not need hep C tx
those with severe comorb + short life expectancy unrelated to HCV
in adults with HCV without cirrhosis and have not received previous hep C tx
1. should receive full hep C tx
2. should receive simplified tx
3. do not need tx- will clear themselves
4. 2 or 3
2
the goal of hep B tx is to achieve SVR- absence of detectable HCV ________________ at least _____ after completion of tx
absence of detectable HCV RNA
12 wks
____ is a marker for cure of HCV infection
SVR
T or F: for a pt to have eradicated the infection, they must be rid of both HCV antibodies and RNA in serum and tissue
F- will still have HCV antibodies
3 oral tx classes for hep B
NS3/4A protease inhibitor (-previr)
NS5B polymerase inhibitors (-buvir)
NS5A inhibitors (-asvir)
NS3A4 protease inhibitor ends with
-previr
NS5B polymerase inhibitors end with
-buvir
NS5A inhibitors end with
-asvir
most intx with hep B tx are
CYP3A4 metabolism
hepatic/ intestinal transporters
describe monitoring for hep B after tx
week 12 after end of tx = do SVR
HCV RNA, AST, ALT
