Viral Hepatitis Flashcards
Where is there a high prevalence of hepatitis infections (3)
South America
Africa
South East Asia
How soon after infection does hepatitis A infection become symptomatic
2-6 weeks
Often subclinical
How is hepatitis A spread
Faeco-oral spread
Is hepatitis A a notifiable disease
Yes
What occurs during a hepatitis A infection (3)
Raised ALT
HAV in stool
IgM
What is left after the hepatitis A virus is cleared
IgG
Anti-HAV IgM
Recent infection (or vaccine)
Anti-HAV-IgG
Recent infection (or vaccine)
Where are HBeAg found
In the core of the virus
Where are HBsAg found
Viral envelope
How is hepatitis B spread (3)
Sexual
Vertical transmission
Blood products
How does hepB present (2)
Acute
Chronic
What is chronic hepB
Infection present for >6 months
What is present in the serum in chronic hepB infection (4)
Anti-HBc
Anti-HBs
Anti-HBe
Anti-HBc IgM
What are the long term consequences of hepatitis B infection (3)
Hepatic fibrosis
Cirrhosis of the liver
Liver cancer
What are the HBV disease stages (5)
Immune tolerant Immune reactive Inactive HBV carrier state HBeAg negative chronic HBV HBsAg negative phase
What did the REVEAL study discover related to HBV infection (2)
Increased incidence of cirrhosis with increasing baseline serum HBV DNA level
Increased incidence of HCC with increasing HBV DNA baseline viral level
What drugs are used to treat chronic HBV (6)
Interferon alpha Lamiduvine Adefovir Tenofovir Entacavir Emtricitabile
What family of viruses does HCV belong to
Flaviviridae
How is HCV spread
Mainly blood product spread
What proportion of HCV infections are chronic
60-80%
What are the two possible outcomes of acute hepatitis C infection (2)
Clears 20-40%
Chronic 60-80%
What is the serology in acute HCV (2)
Sharp spike in ALT
Followed by rise in anti-HCV
What are the long term effects of HCV infection on the liver (3)
Hepatic fibrosis
Cirrhosis
Liver cancer (HCC)
What are the treatment targets for chronic HCV infection (3)
NS3/4 serine protease, RNA helicase. NS5A RNA(unknown action) NS5B RNA dependent RNA polymerase
What are some drugs used to target NS3/4 serine protease in hepatitis C (3)
Teleprevir
Boceprevir
SImeprevir
What are somedrugs used to target NS5A RNA in hepatitis C (3)
Ledipasvir
Daclatasvir
Elbasvir
What drugs are used to target NS5B RNA dependent RNA polymerase in hepatitis C infection (3)
Sofosbuvir
Dasabuvir
Beclabuvir
What rises acutely following hepatitis D infection (3)
IgM anti-HDV
HDV RNA
HBsAg
What is present after HDV infection
Anti-HBs
What is required for HDV infection
HBV infection
What family does HEV belong to
Hepeviradae
Where is HEV present (2)
SE Asia
Africa
What are the different HEV genotypes (2)
Genotypes 1 and 2 - human, epidemic
Genotype 3 and 4 - swine and other (humans accidental hose = zoonosis)
Can HEV be transmitted person-person
Very rarely
What is the incubation period for HEV
3-8 weeks
What is a danger of HEV in pregnancy
Genotype 1 has a high mortality in pregnancy
What are some rare complications of HEV (4)
CNS disease - Bell’s palsy, Guillain Barre, other neuropathy
Chronic infection
What is the treatment for HEV (2)
Supportive
Ribavirin
Is there a vaccine for HEV
Yes - trials with recombinant HEVg1 in Nepalese military and Chinese
How is HEV detected
HEV antigen becomes detectable in stool and serum during the incubation period
What is present in the late stages of HEV infection (2)
IgG anti-HEV antibody
IgM ant-HEV antibody
What is an effective HCV treatment
Peginterferon combination therapy is the best
