Viral Hepatitis Flashcards
What are some clinical manifestations of acute viral hepatitis?
- Fever
- Malaise
- Anorexia
- Nausea
- Vomiting
- Jaundice
- Abdominal/RUQ pain
- Hepatomegaly
Which type of antibody is associated with acute hepatitis A? Which antibody persists after recovery from the disease?
IgM for acute
IgG persists after the disease (immunization)
What is recquired for a hepatitis A diagnosis?
Hep A ag
Hep A antibody (IgM) = acute (6 months)
Hep A IgG = indicates exposure although now immune
How do you prevent Hep A?
- Hand washing
- Sanitation
- Immune Globulin
- Hepatitis A vaccine
Who is recommended to have the Hep A vaccine?
- Infants
- People working in or traveling to areas with high incidence of HAV
- People with chronic liver disease
- People working with HAV
When should preventative immune globulin for Hep A be given to patients who do not have exposure?
When people are travelling and high HAV endemic region
Post exposure immune globulin should be given within ___ days of the exposure
14 days
In what year was the Hepatitis A vaccine licensed?
1995
What is the significance of IgG and IgM in Hep E infection?
IgG signifies a disease more than 6 months prior
IgM signifies acute disease (<6 months)
What is required for a Hep E Diagnosis?
- Hep E ab
- Hep E IgM = acute (<6 months)
- Hep E IgG = previous exposure (>6months) and now immune (protective antibody)
Is there a vaccine for Hepatitis E?
No
In hepatitis B, what is the significance of surface antigen?
What is the significance of E antigen?
Surface antigen indicates an ongoing disease
E antigen indicates virus in the blood stream
In Hepatitis B, which antibody signifies immunity to the virus?
Surface antigen antibody
What is Seroconversion in Hep B?
Losing E antigen and developing E antibody
It indicates that the virus has left the bloodstream
What antibody is not present in chronic Hepatitis B?
Surface antigen antibody
What is required for a diagnosis of Hepatitis B? What is the signficance of core antibody?
- Hep B Surface ag+ = current hep B (acute or chronic)
- Hep B surface ab+ = immune (recovered from natural infection, vaccine)
- Core antibody = natural exposure
- IgM= recent exposure (<6 months)
- IgG= old exposure (> 6 months)
Unvaccinated infants should be vaccinated by what age (Hep B)?
11
Which populations are at greater risk for Hep B infection?
- People with multiple sexual partners
- Sexual partners or household contacts of HBsAg-positive people
- Homosexually active men
- Users of illicit drugs
- Travelers to regions of endemic disease ( > 6 months)
- People occupationally exposed to blood or body fluids
Is the incidence of Hepatitis B increasing or decreasing?
Decreasing since the 1980s
How is the Hepatitis B vaccine administered?
How is it administered to newborns of infected mothers?
- Give hepatitis B immune globulin (HBIG), preferably within 24 hours (but can be given up to a week after)
- Second HBIG dose 1 month after first-or…
- Hepatitis B vaccine, preferably within 24 hours but can be given up to a week after
- Second dose of vaccine 1 month after first
- Third dose of vaccine 6 months after first
- In Hepatitis B surface antigen positive mothers, give newborn both HBIG and vaccine
What are the goals of chronic HBV therapy?
- Eliminate or significantly suppress HBV replication
- Prevent progression to cirrhosis and possibly hepatocellular carcinoma (HCC)
- ALT normalization
- Histological improvement
- Loss of HBeAg, development of HBeAb (seroconversion)
- Loss of HBsAg
How is liver cancer progression different between Hep B and Alcoholic liver disease?
In Hep B, the liver does not have to go through cirrhosis before progression to liver cancer
Medication for Hep B can be stopped after elimination of _____
E antigen (seroconversion)
What are the two mechanisms of treating Hepatitis B?
Activating the immune system (Immunomodulators)
Antiviral therapy (nucleosides/nucleotiedes)
What is used to activate the immune system in HBV therapy?
What enzyme is blocked by nucleosides/nucleotides?
Interferons
Reverse transcriptase
What is the difference between Interferon-alfa-2B and Peg-interferon-alfa-2a?
Peg-interferon alfa-2a is a slow release preparation
What two drugs are considered first line therapy for HBV?
Entecavir and Tenofovir (low resistance rates) - Viral therapy
When should Peg-IFN be used and what are its side effects?
It should be used in HBV with low viral load and high ALT/AST
- SE:
- flu-like symptoms
- neuropsychiatric symptoms/depression
- bone marrow depression
What percentage of HBV patients reach seroconversion/ALT normalization with therapy?
What percentage get the Surface antigen antibody?
30%
5-7% get surface antigen antibody
What is the difference between a co-infection with HDV and a superinfection with HDV?
Co-infection occurs in patients with acute HBV who develop HDV at the same time (infection < 6months)
Super infection is a person with chronic hepatitis B who acquires hepatitis D
In which type of infection does the IgG antibody for HDV go away?
Acute HBV/HDV co-infection (IgG does not go away with chronic infection/super infection)
Note: IgM goes away in both
When did widespread blood screening begin in the US, significantly decreasing cases of HCV? What other disease did this decrease correlate with?
1992; HIV (many of the same risk factors)
What are the two types of protein for HCV?
Structural and non-structural (viral replication)
How is Hep C diagnosed?
Requires presence of Hep C viral RNA (indicates active infection)
Hep C antibody seen in all exposures (never clears even with clearance of disease so cannot be used for diagnosis)
What percentage of patients with acute HCV progress to chronic HCV? What is the difference
80%
Chronic HCV is more likely to show symptoms and viral RNA does not clear
What is the target of the newer HCV medications? (Ledipsavir and Sofosbuvir)
Non-structural proteins (direct acting antivirals)
