Viral Hepatitis

Question 1

Hep B:

-when is it acute, when chronic?

Answer 1

Infection as child: 90% chronic

Infection as adult: 90% acute.

Question 2

HBV/HDV coinfection vs superinfection:

which is worse

Answer 2

superinfection is more severe

Question 3

HBV vaccine

-how many shots over how long?

Answer 3

3 shots over 6 months.

1. today
2. 1 month
3. 6 months

Question 3

Chronic Hep B

-Tx (3 drugs)

Answer 3

1st line Tx:

Nucleotide/nucleoside analogues (reverse transcriptase inhibitors)

1. Entecavir
2. Tenofovir
   - use these for life unless seroconversion achieved

Interferon Tx

(cytokines to activate immune system. pts feel miserable)

3. PEG-interferon alpha

Question 3

Hep D

-describe serology, timeframe

Answer 3

IgM: acute

IgG only: >6 months

-however, IgG is NOT protective Ab

Question 4

Chronic Hep B tx:

goals (3)

and rates of success

Answer 4

Goals:

1. Significantly suppress HBV replication: 30% achieve this
2. Prevent progression to cirrhosis/HCC

ALT normalization: ~30% achieve

3. Seroconversion (loss of infectivity): ~30%

Bonus: loss of surface Ag (virus totally removed)–5% achieve

Question 5

Hep C

-target of direct acting antivirals

Answer 5

Non structural viral proteins

eg RNA dependent RNA polymerase for viral replication

Question 5

Hep E:

-what population is esp vulnerable

Answer 5

pregnant women: HEV infection assoc with fulminant hepatitis.

Question 6

Acute viral hepatitis

clinical presentation

Answer 6

1. Fever
2. Malaise
3. Nausea/Vomiting
4. Anorexia
5. Jaundice
6. RUQ pain
7. hepatomegaly

Question 8

Hep E

-describe serology, timeframe

Answer 8

Just like Hep A

• IgM present for first 6 months
• IgG indicates exposure and is protective

Question 10

Acute Hep B:

Tx

Answer 10

Supportive, fluids

Question 10

Hep C:

what % of pts clear disease entirely

Answer 10

20%

Question 12

Chronic Hep B:

-increased risk of what complication?

Answer 12

-hepatocellular carcinoma (only liver disease that does not require progression to cirrhosis before HCC)

Question 13

Hep A

-describe serology, timeframe

Answer 13

IgM: acute

IgG: previous exposure (>6 months). protective.

Question 14

Unvaccinated Hep B person gets exposed through needlestick. How to prevent?

Answer 14

1. give HBIG (immunoglobulin) within 1 week (best in 24 hrs)
2. also give Hep B vaccine within 1 week (best in 24 hrs)

Question 16

Hep A

• when to use which?
  1. Hep A vaccine
  2. immunoglobulin

Answer 16

1. Hep A vaccine (pre exposure)
   - 2 shots 6 months apart
2. immunoglobulin (pre and post exposure)
   - pre if traveler didn’t start 6 months earlier for vaccine
   - post exposure within 14 days

Question 17

What is the only liver disease that can cause hepatocellular carcinoma w/o first going to cirrhosis?

Answer 17

Hep B

Question 18

Hep B

• what and when is the window period?
• why to know?

Answer 18

8 week Window period btwn weeks 24-32 in acute Hep B infection.

HBsAg disappears week 24.

HBsAb (protective) appears week 32.

-to dx Hep B infection during window, must look at IgG and IgM core antigen. IgM present until 6 months. IgG only is >6 months.

Question 19

Serology:

what does each indicate? At what time does each elevate in blood?

1. Hep C Ab
2. viral RNA

Answer 19

Hep C Ab seen in all exposures, even after virus is cleared. Appears 2-3 months.

Viral RNA present only in active infection. appears 2 weeks.

Question 20

Hep B

• describe serology, timeframe
  1. HBsAg
  2. HBeAg
  3. HBcAb
  4. HBsAb

Answer 20

1. HBsAg
   - surface antigen. indicates current infection. in Acute, disappears at week 24
2. HBeAg
   - envelope antigen. indicates infectivity. Seroconversion in acute infection.
3. HBcAb
   - core Ab. You can get this only with infection, not vaccine. IgM indicates acute (6 mo
4. HBsAb
   - IgG surface Ab. indicates protection. If obtained after infection, appears at week 32.

Question 21

Hep B+ mothers: what to give to newborn?

Answer 21

Give vaccine and HBIG to newborn. Risk decreases from 90% to 2%