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Flashcards in 13. Viral Hepatitis Deck (87):
1

Acute viral hepatitis in the US is most commonly due to

HepB (51%)

2

What is the most common cause of chronic viral hepatitis in the US?

HepC
**B is the second MCC

3

What kind of genome does HAV have? Transmission?

RNA virus
Fecal-oral
**single serotype, only infects humans

4

Incubation period of HAV

Mean 4 wk
2-6 wk range

5

Who gets symptomatic HAV infection?

Adults 70-80%
Only 10% children with infectious are symptomatic

6

Fatality with HAV infection

Overall 0.3%
1.8% over 50 yo

7

Chronicity with HAV and HEV?

NO

8

Where is there a high prevalence of HAV infectious?

South America
Africa
Southeast asia

9

What body fluid have the highest concenrtation of HAV?

Feces **
Serum
Saliva

10

What is the most common method of transmission of HAV?

Personal contact **
Day care centers
Foreign travel
Food outbreaks not very common

11

Who is more at risk for HAV infection?

Children
Though adults are at lower risk for infection, they have higher mortality

12

What rises first following HAV, aside from fecal HAV?

ALT level spikes

13

What are the two components of the anti HAV antibody and what is their trajectory?

IgM anti-HAV: rises and falls, marks acute infection
IgG anti-HAV: rises and persists, resistance

14

Transmission of HEV

Fecal oral
Contaminated drinking water
Minimal person to person contact

15

What is the incubation period for HEV?

40 days

16

What is the general fatality for HEV? Who has a higher fatality rate?

1-3%
Pregnant women 15-45%

17

Where is HEV most common?

Northern Africa
SE asia

18

What does the IgM increase in HEV infectious coorespond to?

Acute bout of hepatitis

19

What kind of genome does HBV have? What does it infect?

DNA virus
Humans, some primates

20

What is the incubation period of HBV?

60-90 days

21

Acute case fatality for HBV

0.5-1%

22

What determines the chronicity of HBV infection?

Age of exposure

23

What is HBV infection the leading cause of worldwide?

Hepatocellular carcinoma

24

What is the distribution of HBV

Africa
SE Asia
Alaska

25

What is the difference between children and adults being exposed to HBV?

Children: VERY HIGH chance of chronicity
Adults: Low risk of developing chronicity, but more likely to have a symptomatic infection

26

What body fluids have a high concentration of HBV? Moderate? Low?

High: blood, serum, wound exudates
Moderate: semen, vaginal fluid, saliva
Low: urine, feces, sweat, tears, breastmilk

27

What is the #1 risk factor for transmission of HepB?

Heterosexual transmission

28

What two levels rise and then fall with acute HBV infection with recovery? Which one does not fall in a chronic infection?

HBsAg **doesn't fall in chronic infection
IgM anti-HBc

29

What increases 8 weeks after HBsAg levels disappear?

anti-HBs
**window period between

30

The presence of ___ indicates immunity to HBV

Anti-HBs

31

What defines chronicity of HBV infection?

Presence of HBsAg for over 6 months

32

In HBV infection, what indicates infectivity?

HBeAg

33

What is the term for development of anti-HBe in HBV infection without immunity?

Seroconversion

34

What two components remain high in a chronic HBV infection?

Total anti-HBc (high in recovery too)
HBsAg

35

What is a key difference between the development of cancer from HBV vs HCV?

HBV: Cancer can develop from cirrhosis or directly from chronic infection
HCV: Chronic infection must progress through cirrhosis to cause cancer

36

Risk for children vs adults to develop chronic from acute HBV infection

Children >90%
Adules <5%

37

What % of people with chronic infection develop cirrhosis? Liver cancer directly?

30%
5-10%

38

What are two potential consequences of cirrhosis from HBV infection?

Liver failure 23% in 5 yr
Liver cancer
**both make patients candidates for transplant

39

When is the only time you can get HDV

In conjugation with HBV infection

40

What are the two ways that HDV infection can occur?

Coinfection: more severe, but less likely to become chronic
Superinfection: greater risk of chronic disease

41

What happens to IgG in HDV infection

Typically cleared from the bloodstream

42

HCV has both ___ and ___ genes

Structural
Non-structural

43

What type of genome does HCV have? half life? daily virion production

RNA
2.7 hr
10^12 virions (very rapid replication)

44

What is the most common genotype of HCV in the US?

Type 1A: 37% **
Type 1B: 30% **
Type 2: 10%
Type 3: 6%

45

Why are different HCV genotypes important?

Respond differently to therapy

46

What is the most common type of HCV transmission?

IV drug abuse

47

When does the ALT spike in HCV infection?

203 months

48

What confirms the dx of HCV infection?

HCV RNA

49

What affects rate of progression to fibrosis in HCV infection?

Factors like alcohol, obesity, etc

50

After the acute phase of HCV infection, what % is resolved and what % is chronic?

Resolved: 15%
Chronic: 85%

51

What % of chronic HCV infection progresses to cirrhosis?

20%

52

What are two possible progressions from cirrhosis in HCV infection?

1. ESLD (6%/yr)
2. HCC (4%/yr)

53

What is the #1 indication for transplant in the US?

ESLD or HCC due to HCV

54

Does HepC have a fulminant hepatitis stage?

No--damage takes time

55

What are the clinical manifestations of acute viral hepatitis?

Fever
Malaise
Anorexia
Nausea/vomiting
Jaundice
Abdominal/RUQ pain
Hepatomegaly

56

What does it mean if a person is + for HepA antibody by negative for IgM?

Person had pervious exposure and is immune

57

How can HepA be prevented?

Hygiene
Sanitation
Immune globulin (pre and post exposure)
Hepatitis A vaccine (pre exposure)

58

What 4 types of people should get the HepA vaccine?

1. Infants
2. People traveling to endemic areas
3. People with chronic liver disease
4. People working with HAV

59

Who should get pre-exposure immune globulin for HAV?

Travelers going to endemic areas who are leaving within two weeks, making the vaccine ineffective

60

Who should get post-exposure immune globulin?

People with household or intimate contacts
Outbreaks in institutions
Common source exposure (Taco Bell)

61

What does it mean if a patient is IgM + for HEV?

Acute HepE infection

62

What is consistant with acute disease in HBV infection?

IgM anti-HBc

63

What must be used for dx of HBV infection in the window period?

IgM anti-HBc

64

What does HBsAg + indicate?

Current HepB infection, acute or chronic

65

What does anti-HBs + indicate?

Immunity
**cant tell if this is from vaccine or natural infection

66

How do you tell if anti-HBs is from vaccine or a natural infection?

Presence of core antibody--will only be present with natural infection
IgM--recent exposure
IgG--old exposure (>6mo)

67

What is the most important indication for HBV vaccine?

People occupationally exposed to blood or body fluids

68

What makes the HBV vaccine less effective?

Old age and debilitation

69

What are two options for hepatitis B exposure in unvaccinated patients?

1. Giving hepatitis B immune globulin within 24 hr, up to a week after-->second dose 1 mo after the first
2. HepB vaccine within 24 hr, up to a week after -->second dose 1 mo after and third dose 6 mo after

70

What should be done in the case of a HBsAg + mother giving birth?

Newborn should get boths HBIG and vaccine
**90% risk of vertical transmission without treatment

71

What are the goals of HepB therapy?

1. Repress HBV replication
2. Prevent cirrhosis and HCC
3. ALT normalizaiton
4. Histologic improvement
5. Loss of HBeAg and seroconversion to anti-HBe
6. Loss of HbsAg ******

72

What are the two modes of tx of chronic HBV infection?

Interferon:cytokines released by host cells, activate the immune system
Antiviral therapy: block reverse transcriptase which is needed for HBV replication

73

What is the main drawback of interferon tx?

Flu like sx: headaches, fevers, and muscle aches

74

What are the two first line tx for HBV therapy?

Entecavir and Tenofovir: associated with low levels of resistance (anti virals)

75

What treatment can be used along with entecavir and tenofovir in a very specific population of people with HBV infection (low viral load, high ALT/AST)

Peg-IFN

76

What are the SEs of Peg-IFN?

Flu-like sx
Neuropsychiatric sx and depression
Bone marrow depression

77

When is HepD IgG more likely to persist

With superinfection

78

What indicates acute HepD infection? Previous exposure?

IgM
IgG **NOT PROTECTIVE

79

What will be the HCV antibody level and viral RNA level if the infection is cleared? Uncleared?

Cleared: anti-HCV + and viral RNA negative
Uncleared: anti-HCV + and viral RNA positive

80

In the case of HCV, ___ is present with all exposures while ___ is present only in those that are viremia

HepC antibody
HepC RNA

81

What is the standard of care for HCV therapy?

Interferon-based therapy (immune activation)

82

Eradication rate for genotype 1? Genotype 2/3?

50-60%
80-90%

83

Eradiation rates for HCV are based on:

Undetectable virus 6 months after completion of therapy

84

What is the next step for a patient with high transferrin saturation?

HEF testing

85

What antibody will most likely be high in a woman with dry eyes and elevated liver enzymes with VERY HIGH ALP?

Anti-mitochondrial antibody

86

What tx is appropriate for a patient with AIH?

Prednisone
Azothioprine

87

How do you determine the long term prognosis of a patient with liver disease?

INR