Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
60 Cards in this Set
- Front
- Back
|
HBV
|
hepadnavirdiae family
enveloped DNA virus double stranded circular DNA genome replicates through RNA intermediate only infects humans and apes DNA polymerase is key enzyme in replication |
|
|
cccDNA
|
covalently closed ciruclar DNA
inside nucleus serves as template for transcription of viral RNA in HBV 5-50 copies/hepatocyte stable form of viral DNA that is most resisiant to antiviral therapy and host immunologic response |
|
|
HBV
|
50 nm
double-shelled orginially claaed the Dane particles endogenous DNA polymerase |
|
|
HBsAG
|
envelope antigen
|
|
|
HBcAg
|
core antigen
|
|
|
HBeAg
|
nucleocapsid antigen
|
|
|
HBV transmission
|
sexually via semen, vaginal fluid, saliva
patenterally via blood/serum/wound perinatal |
|
|
8 HBV genotypes
|
A - US & Europe
B & C - Asia D - mediterrnean & middle east |
|
|
genotype A
|
HBeAg (nucleocapsid antigen) have better response to INF
only time consider gentypic testing |
|
|
HBV infection
|
most are transient
recurrent infection > 6 months = chronic HBV infection |
|
|
acute hepaititis
|
all same symptoms except HBC is usually asymptomatic
N/V abdominal pain anorexia fever diarrhea light, clay colored stools dark urine jaundice |
|
|
chronic HBV
|
failure of host immune response
90% of newborns and immunocompromised 30% of children usually asymptomatic compared to acute infection |
|
|
HBV incubation
|
60-90 days
|
|
|
HsAg
|
1st marker of active HBV infection
|
|
|
Pregos with HBV
|
passive active immunoprophylaxis with hepatitis B immunoglobulin and Hep B vaccine at birth
|
|
|
tx HBV with
|
Peg-INF
NRTIs (entricibatime (FTC), LAMIVUDINE (3tc) TENOFAVIR (TDF) adafavir entecarivr all have to be renally dosed because all metabolized renally targe HBV polymerase which is responsible for priming of reverse transcription, reverse transcription, and chaperone |
|
|
PEG-INF
|
known benefit in gentorype A, compensated cirrhotic patients, low serum HBV DNA, and minimal liver fibrosis
|
|
|
lamivudine
|
3TC
NRTI can use in HIV & HBV use in pregos and decompensated cirrohosis |
|
|
adenovir
|
activity agaisnt wild-type HBV and LAM-resisitant HBV.
not potent causes renal tubular injury |
|
|
entecavir
|
has to be used with HAART because has activity agaisnt HIV (cause resistance)
potent inhibitor of HBV polymerase LESS NEPHROTOXIC |
|
|
Telbivudine
|
only has HBV activity
|
|
|
tx not indicated for
|
Alt is low
HBV DNA is low no histologic evidence of viral disease |
|
|
Hep B vaccine
|
contains HBsAg
3 doses at 0,1,&6 months indicated for all health care workers boosters are not currently recommended |
|
|
HBV
|
leading cause of chronic hepaittis, cirrhosis, and heptocellurl carcinoma
|
|
|
HBV incubation
|
4-10 weeks
followed by symptomatic pahse when ALT levels spike then serogentative conversion to anti-HepBcAg (core antigen) |
|
|
anti-Hbc
|
indicates acute/chronic infection
|
|
|
Hep B vaccine
|
active immunity
|
|
|
Hep B immunoglobulin
|
temporary passive immunity
dose 0.06 mg/kg |
|
|
Hep A & E
|
transient infection followed by resolution
|
|
|
Hep B, C, & D
|
cause life long persistent infection with ongoing viral replication in liver and persistent viremia
|
|
|
HepC chronic infection
|
85% of patients upon exposure
|
|
|
HCV
|
linear single stranded RNA viruse of flavividae family
1 trillion virons/day 6 genotypes |
|
|
transmission of Hcv
|
BLOOD
intranasal (cocaine) percutaneous or permucosal (perinatal/anal sex) IVDA is most common transmission |
|
|
HCV
|
decreasing in incidence
increase morbitity and mortality chronic infection causes 10,000 deaths/year |
|
|
factors that increase fibrosis
|
alcohol
HIV co-infection steatosis (fatty liver disease) age > 40 yr |
|
|
Dx Hcv
|
HCV ab and HCV RNA in the blood
vaccinate Hep A & B tx for 6-12 months with PEG-INF |
|
|
cure for HCV
|
SVR
lack of detectable HCV RNA in the blood 6 moths after stopping tx |
|
|
INF
|
inhibits viral replication in host cells, suppresses cell proliferation and cause immunodialtion
PEG-INF increase t1/2, reduces clearance and extends therapuetic action -pegltron(2b) -pegasys(2a) |
|
|
tx HCV
|
PEG-INF
Qweek at same time of day in thigh/abdomen |
|
|
ribavirn
|
synthetic nucleoside anaolgue
activity for RNA/DNA viruses monotherapy not effetive enhances viral clearance with INF ADMINISTER WITH FOOD renally dosed |
|
|
INF AEs
|
pyschiatric AEs
monitor for depression |
|
|
ribavarin DIs
|
no ddi(don't do it!!!) causes lactic acidosis/pancreatitis/liver decompsition
stadvudine increase lactic acidosis w/ribavarin Ziduvudine increases anemia and nuetropenia |
|
|
HCV
|
most common blood born infection
|
|
|
dx HCV
|
reactive enzyme immunoassay for anti HCV
|
|
|
genotype I for HCV
|
has best tx response!
|
|
|
HDV
|
cannot replicate
small subviral agen encapsultaed by HBsAg requires presecence of HBV to provide envelope protein because it does not encode for it |
|
|
dx HDV
|
HDAg abs
transmitted and tx same as HBV |
|
|
HAV
|
noneneveloped
single stranded RNA picornavirus family single serotype no chronic infection |
|
|
HAV transmission
|
fecal-oral
to lesser extent blood |
|
|
HAV incubation
|
30 days
|
|
|
IgM anti-HAV
|
serologic marker of acute HAV
adults have more severe rxn than kids |
|
|
Hep A vaccine
|
2-dose schedule
highly immunogenic |
|
|
immunoglobulin
|
concentrated Abs
prevent HAV when administered before exposure pre and post pre-exposure when <2-4 wks get vaccine not enough time to build Abs |
|
|
HEV
|
noneveloped
single stranded positive sense RNA causes only acute disease Calicivirdae family fecal-oral transmission life-threatening in pregos |
|
|
HEV incubation
|
40 days
rare in US endemic in developing countries |
|
|
HAV
|
feces
fecal-oral no chronic infection prevent with pre/post exposure Abs and vaccination |
|
|
HBV
|
blood/body fluids
transmit perutanous/perimucosal chronic infection pre/post exposure/vaccination |
|
|
HDV
|
blood/body fluids
transmit perutanous/perimucosal chronic infection pre/post exposure/vaccination and risk behavior modification |
|
|
HCV
|
blood/body fluids
transmit perutanous/perimucosal chronic infection blood donor screening and risk behavior modification |
|
|
genotype 2 of HCV
|
is the hardest to erradicate
|
