Viral Hepatitis: Nair Flashcards
3 clinical presentations of viral hepatitis:
Acute hepatitis
Fulminant liver failure
Chronic hepatitis
3 complications of chronic hepatitis:
Cirrhosis (20-30 yrs of chronic hepatitis)
Liver failure
Hepatocellular carcinoma
Which form(s) of hepatitis (A-E) can end resolution w/o treatment?
A and E
Which form(s) of hepatitis (A-E) can lead to chronic hepatitis?
B, C, D (further down alphabet, more protracted course)
Which form(s) of hepatitis (A-E) can lead to acute hepatitis?
A, B, C, E
only HDV only leads to chronic
HCV is USUALLY chronic (think: C = chronic, A = acute, B = both)
IV drug users have:
HCV
Healthcare worker gets stuck w/ a needle and 2 weeks later has hepatitis, they have:
HCV
Not stuck by needle, but have acute Hep? You have:
HAV or HBV
Labs for acute hepatitis:
High AST/ALT- >1000IU/L
High bilirubin, PT/INR
Very high INR (>4) may inducate progression to fulminant hepatic failure
Your pt is infected at week 0. Describe the clinical course of acute hepatitis in terms of illness and rise and fall of liver enzymes, IgG, IgM from week 0 to week 13.
Enzymes and IgM peak at week 4 and 6, respectively. IgM drops after wk 6 steadily. IgG rises slowly over entire course. Enzymes back to normal by week 9. Clinical illness lasts from weeks 2-8.
Most common outcome of HAV and HBV?
Spontaneous resolution.
Most common outcome of HCV?
Chronic infection.
How do you dx acute hepatitis?
Ab titers for IgM anti HAV, HBV, HEV
What does the presence of IgG?
Prior infection. Either resolved or active chronic.
What does the presence of viral RNA or DNA show?
Active infection, but does not differentiation btwn acute or chronic.
Which viral cause of hepatitis is the only one that is a DNA virus (A-E)?
HBV
A dx of chronic hepatitis can be made using several lab/clinical findings, including ALT/AST levels how many times the normal (~19-25)?
Presence of a positive titer for HBsAg (HBV surface antigen) means:
Active infection w/ HBV (either acute or chronic)
It is the most important test!
When do you treat chronic HBV?
When there is evidence of liver injury (high ALT) or advanced liver fibrosis
How do we tx HBV?
Entecavir- long duration of tx, targets HBV replication
Tenofovir
HDV is unique in that it requires what to infect its host?
What is the big deal w/ HDV?
Host must have HB surface antigen, meaning prior infection w/ HBV.
::HDV increases severity of HBV infection and increases risk of cirrhosis.
Which viral cause of hepatitis can be cured?
Why can it be cured, compared to the others?
What is this magical cure?
HCV (C=cure, chronic)
Cure is attributable to fact that HCV never enters nucleus of host cell. Drugs can reach it in the cytoplasm.
Tx: Sofosbuvir (NS5B polymerase inhibitor) + Ledispavir (NS5A poly. inh.) HARVONI- trade name. Tx for Genotype 1, MC genotype in US.
No major side effects.
_______ is now the leading cause of death in HIV pts.
HCV
Many HIV drugs (Tenofovir) have co-activity in treating this viral cause of hepatitis:
HBV
Describe some strongly associated extrahepatic manifestations of HCV/HBV.
Mixed cryoglobulinemia Sjogren syndrome Lymphoproliferative disorders Porphyria Neuropathy Membranoproliferative glomerulonephritis Cryoglobulinemic vasculitis
List other viral sources of hepatitis.
List lab values.
Self-limiting or nah?
:: CMV- transplant pts. Prophylaxis w/ valcyclovir. tx: ganciclovir.
:: Epstein-Barr
:: Herpes
ALT/AST 300-600 IU/L
Self-limiting, except in immunocompromised.
