12 Treatment of viral Hepatitis Flashcards
what can adults with acute hep infection get
- subclinical infection
- acute icteric hepatitis
- fulminant hepatitis (10%)
- chronic infection (10%)
what are the possible chronic infection consequences
- healthy
- chronic hepatitis
- cirrhosis ca liver
what are the HBV therapy modalities: Immunomodulators
- Interferon
- Pegylated interferon
what causes ALT rise
Rise in ALT due to interferon stimulating cytotoxic T cell response
= increase cell death
what is needed for to stimulate T cells in interferon-based therapy
In order to stimulate T cells – cytotoxic T cell need to recognise virus
what is the effect of T cell recognises virus in interferon based therapy for HBV
Enhances expression of HLA Class 1 molecules on hepatocyte surface
Enables circulating cytotoxic T cells (CTL) to recognise virally infected cells – and kill them
Reduces burden of infected hepatocytes
what are the HBV therapy modalities RT
Reverse transcriptase inhibitors worked
- hep DNA load will drop = stop virus replication
= prevent virus growing so no liver damage
why must considered in antiviral HBV therapy using NA
- if use nucleoside analogue, have to consider:
> potency
> barrier to resistance
what is the HCV treatment aim
Aim of treatment - sustained loss of detectable circulating virus – i.e. virological cure
- wanting to cure the patient
- aiming to remain RNA -ve = called SVR sustained virological response
what is the effect of pegylated interferon
Covalent bonding of PEG to IFN
If inject interferon into someone the levels rise then after around 24hrs completely gone from peripheral blood
what are the interferon side effects
- Flu-like symptoms
- Fatigue
- Depression
- Autoimmune disease
what are the Ribavirin side-effects
- Anaemia
- Teratogenic (birth defects)
- Gastro upset
what are the different classes of direct acting antiviral agents (DAA)
- bind to the active site with nucleotide/nucleoside inhibitor
- or can bind elsewhere with non-nucleotide/nucleoside inhibitor
when treat patients with Peg-IFN and ribavirin what is the % cure
50%
what is NS5a inhibitors
multifunctional protein, many host protein binding partners
