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73 Cards in this Set
- Front
- Back
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What is the genome of the hepatitis B viruses?
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All RNA EXCEPT for hepatitis B
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What are the acute viral hepatisies?
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A
E |
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What are the more chronic hepatitis viruses?
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B
C D |
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What's the transmission of the chronic hepatitis viruses?
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Parenterally
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What's the transmission of the acute viral hepattitises?
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Fecal-oral
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What types of hepatitis are able to be prevented by vaccine?
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A
B E D (as it is dependent on B) |
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What type of hepatitis is most common in the US?
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C
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What population is at high risk from hepatitis E?
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Pregnant women in the 3rd trimester
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What's the presentation of hepatitis A in kids? Older adults?
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Kids: not serious at all - they just stop being as active
Older adults: very bad! risk of mortality |
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How do you diagnose the different kinds of hepatitis?
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IgM against the viruse during the acute phase
In Hepatitis C, you need the RNA |
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What determines if Hepatitis B will be chronic?
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Age
Immune status |
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Who gets chronic hepatitis E?
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Immunosuppressed
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What's the presentation of hepatitis A in kid? Adults?
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Kids: no symptoms
Adults: symptoms of acute hepatitis: -Anorexia -Constitutional symptoms -Fagtigue -Serum-sickness |
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What increases the intensity of a hep A infection?
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Underlying liver disease
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What are indications for hep A vaccination?
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Kids > 1 year
Travelers to endemic areas MSM Illegal drug users Hemophiliacs People with chronic liver disease |
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What are the forms of the hepatitis A vaccine?
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Hep A vaccine: 2 doses
Combined A and B: 3 doses; 0, 1 6 months |
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Where is hepatitis B commonly found
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Asia
Africa Centrla, south America |
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What population is hepatitis B most common in?
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Immigrants from endemic areas
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What are the recommendations for HBV screening?
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People from 3rd world countries
People not vaccinated as infants, kids of immigrants TIssue/blood donors Pregnant women High risk groups: MSM, dialysis, partners of carriers People who will be immunosuppressed |
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What is the most dangerous complication of HBV infection?
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Fulminant hepatitis
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Why should we screen pregnant women for hepatitis B infection?
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Due to the fact that their kids are at high risk of a chronic HBV infection if they get the disease1
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What are the outcomes of a chronic hepatitis B infection?
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Altering through an inactive carrier state and chronic hepatitis
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What are the possible outcomes of HBV-caused chronic hepatitis?
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Cirrhosis
HCC |
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What antibody is used to test for acute HBV infection?
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Anti-HBc IgM
Antibody against the core |
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How do you test for immunity to HBV?
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Anti-HBs
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How do you test for a high infectivity in HBV?
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HBeAg
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What are the interpretations of HBV serology?
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Total anti-HBc: marker of infection
Anti-HBs: immunity HBsAg: infection |
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What gives you the measurement of infectivity for Hepatitis B?
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Serum HBV DNA levels
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What's the relationship between HBV levels and ALT levels?
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Not correlated, always
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What complications are present due to persistently high HBV serum levels/
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Cirrhosis
HCC |
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What's the family of the HBV?
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Enterovirus
Gets rid of coat upon entry to the cell |
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What is the structure of the DNA within HBV?
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Complete strand
Incomplete strand After repair, you get two complete strands which twist around each other and stick to histones |
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What process occurs inside HBV that doesn't occur in human cells?
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Reverse transcription
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What are the stages of chronic HBV infection?
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1. Immune tolerance phase (early)
2. Immune clearance phase: vius goes away! 3. Seroconversion 4. Reactivation |
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What are risk factors for HCC in HBV?
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Viral:
Persistently high DNA load Core promoter variant HBV genotype: C>B Host factors: Age M>F Asians Coinfection, etc External: Alcohol Aflatoxin Smoking |
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What are the goals for HBV treatment?
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Suppression of HBV replication
Decrease hepatic complications Prevent progression to cirrhosis, liver failure, etc. |
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How do we know if treatment to HBV is successful?
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Decrease in serum HBV DNA
Undetectable viral load: surface antigen negative. Normalization of liver function |
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What are indications for treatment of HBV?
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Likelihood of adverse outcomes: cirrhosis/HCC
Likelihood of long-term benefit with treatmnet High ALT Fibrosis on biopsy |
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What are treatments for HBV?
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Interferon alpha 2a, b
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What's the effect of INF-alpha on HBV infection?
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Stimulation of host immune response
Antiviral activity |
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How long is someone on interferon for HBV? Nucleoside/tide analogues?
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Interferon: 12 months
Nucleoside/tide analogues: life! |
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What are the side effects of interferon? Nucleoside/tide analogues?
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Interferon: Many
Nucleoside/tide: rare; adefovir/tenofovir have nephrotoxicity |
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What are the first-line drugs for HBV?
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Adefovir
Tenofovir |
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What protein is in the HBV vaccine?
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HBs
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What is the dosing for HBV vaccine?
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3 doses
Months: 0, 1, 6 |
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What are factors that lend to a poor response to the HBV vaccine?
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Old age
Chronic illness Decreased immune response Obesity Genetics |
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What are indications for HBV vaccine?
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All infants
All kids and adolescents who weren't vacinated at birth Adults at risk of infection |
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What is the impact of HBV vaccine on HCC?
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Decreases it!
The vaccine prevents cancer! |
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Who should we screen for hepatitis C?
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Transfusions before 1990
Drug users Needlesticks Sex related stuff Offspring of infected mothers Dialysis patients |
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How do you go about diagnosing HCV?
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Hepatitis C antibody: indicator of exposure
Hepatitis C virus RNA: mark of presence of the virus/ongoing infection |
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What's the correlation between HCV RNA levels and severity of disease?
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No correlation
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What are the most common genotypes of Hepatitis C?
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Genotype 1
Genotype 2, 3 |
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Which HCV genome responds best to treatment? Worst?
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2, 3 respond best
1 responds not well |
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What are the symptoms of an acute hepatitis C infection?
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Nothing!
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What is the most common symptom of chronic hepatitis C infection?
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Fatigue!
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When do HCV symptoms manifest?
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Late stage!
It's a silent killer. |
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What are the common symptoms of hepatitis C infection?
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Fatigue
Anorexia RUQ discomfort Extrahepatic: renal, skin, neurologic |
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What are the factors affecting progression of HCV?
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Age at infection
Alcohol consumption Gender Immune function Obesity |
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What are the labs that you order up for HCV?
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HCV RNA< Genotype
LFTs CBC+P PT Look for HBV, HIV Look for HCC Abdominal US +/- biopsy |
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Is HCV curable?
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YES!
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What is the effect of IL28B muttions to HCV treatment? Who has this?
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You get a worse response to HCV therapy
Black patients |
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What are the side-effects of interferon?
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Flu
Fatigue Mood changes Sleep disturbances Hair loss Decreased whic, platelet counts Retinal hemorrhage |
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What are the side effects of ribavirin?
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ANEMIA!
TERATOGENIC! Dry cough Puritis Decreased appetitie |
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What should you give someone who has HCV?
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INF
Protease inhibitors Ribavirin |
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What are the side effects of telaprevir and boceprevir?
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Anemia
Just telaprevir: skin rash, anorectal discomfort |
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Who with HCV should be treated?
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Advanced fibrosis
Early stage liver disease Relapsers and partial responders |
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When can someone get hepatitis D?
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Coinfection with D
Superinfection with B, then they get exposed to D |
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Who should be tested for hepatitis D?
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People with acute hepatitis:
-Anti HBsAg+ and IgM anti HBc+ -Severe course -Risk factors Chronic liver disease -HBsAg+ -Active liver disease despite low HBV DNA -Risk factors |
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What are the sequelae of acute HDV infection? Superinfection?
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Acute:
-Recovery -Fulminant hepatitis -Chronic hepatitis Superinfection: -Chronic hepatitis -Fulminant hepatitis |
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What's the treatment for HDV?
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Interferon is the only one that works
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How do you prevent HDV infection?
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Vaccine for HBV
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What is hepatitis E similar to?
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Hepatitis A
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What are risk factors for HEV?
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Endemic areas: asia, mexido
Pigs Ingestion of raw meat |
