Flashcards in 13. Viral Hepatitis Deck (87):
Acute viral hepatitis in the US is most commonly due to
What is the most common cause of chronic viral hepatitis in the US?
**B is the second MCC
What kind of genome does HAV have? Transmission?
**single serotype, only infects humans
Incubation period of HAV
Mean 4 wk
2-6 wk range
Who gets symptomatic HAV infection?
Only 10% children with infectious are symptomatic
Fatality with HAV infection
1.8% over 50 yo
Chronicity with HAV and HEV?
Where is there a high prevalence of HAV infectious?
What body fluid have the highest concenrtation of HAV?
What is the most common method of transmission of HAV?
Personal contact **
Day care centers
Food outbreaks not very common
Who is more at risk for HAV infection?
Though adults are at lower risk for infection, they have higher mortality
What rises first following HAV, aside from fecal HAV?
ALT level spikes
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
Transmission of HEV
Contaminated drinking water
Minimal person to person contact
What is the incubation period for HEV?
What is the general fatality for HEV? Who has a higher fatality rate?
Pregnant women 15-45%
Where is HEV most common?
What does the IgM increase in HEV infectious coorespond to?
Acute bout of hepatitis
What kind of genome does HBV have? What does it infect?
Humans, some primates
What is the incubation period of HBV?
Acute case fatality for HBV
What determines the chronicity of HBV infection?
Age of exposure
What is HBV infection the leading cause of worldwide?
What is the distribution of HBV
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
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
What is the #1 risk factor for transmission of HepB?
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
What increases 8 weeks after HBsAg levels disappear?
**window period between
The presence of ___ indicates immunity to HBV
What defines chronicity of HBV infection?
Presence of HBsAg for over 6 months
In HBV infection, what indicates infectivity?
What is the term for development of anti-HBe in HBV infection without immunity?
What two components remain high in a chronic HBV infection?
Total anti-HBc (high in recovery too)
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
Risk for children vs adults to develop chronic from acute HBV infection
What % of people with chronic infection develop cirrhosis? Liver cancer directly?
What are two potential consequences of cirrhosis from HBV infection?
Liver failure 23% in 5 yr
**both make patients candidates for transplant
When is the only time you can get HDV
In conjugation with HBV infection
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
What happens to IgG in HDV infection
Typically cleared from the bloodstream
HCV has both ___ and ___ genes
What type of genome does HCV have? half life? daily virion production
10^12 virions (very rapid replication)
What is the most common genotype of HCV in the US?
Type 1A: 37% **
Type 1B: 30% **
Type 2: 10%
Type 3: 6%
Why are different HCV genotypes important?
Respond differently to therapy
What is the most common type of HCV transmission?
IV drug abuse
When does the ALT spike in HCV infection?
What confirms the dx of HCV infection?
What affects rate of progression to fibrosis in HCV infection?
Factors like alcohol, obesity, etc
After the acute phase of HCV infection, what % is resolved and what % is chronic?
What % of chronic HCV infection progresses to cirrhosis?
What are two possible progressions from cirrhosis in HCV infection?
1. ESLD (6%/yr)
2. HCC (4%/yr)
What is the #1 indication for transplant in the US?
ESLD or HCC due to HCV
Does HepC have a fulminant hepatitis stage?
No--damage takes time
What are the clinical manifestations of acute viral hepatitis?
What does it mean if a person is + for HepA antibody by negative for IgM?
Person had pervious exposure and is immune
How can HepA be prevented?
Immune globulin (pre and post exposure)
Hepatitis A vaccine (pre exposure)
What 4 types of people should get the HepA vaccine?
2. People traveling to endemic areas
3. People with chronic liver disease
4. People working with HAV
Who should get pre-exposure immune globulin for HAV?
Travelers going to endemic areas who are leaving within two weeks, making the vaccine ineffective
Who should get post-exposure immune globulin?
People with household or intimate contacts
Outbreaks in institutions
Common source exposure (Taco Bell)
What does it mean if a patient is IgM + for HEV?
Acute HepE infection
What is consistant with acute disease in HBV infection?
What must be used for dx of HBV infection in the window period?
What does HBsAg + indicate?
Current HepB infection, acute or chronic
What does anti-HBs + indicate?
**cant tell if this is from vaccine or natural infection
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
IgG--old exposure (>6mo)
What is the most important indication for HBV vaccine?
People occupationally exposed to blood or body fluids
What makes the HBV vaccine less effective?
Old age and debilitation
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
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
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 ******
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
What is the main drawback of interferon tx?
Flu like sx: headaches, fevers, and muscle aches
What are the two first line tx for HBV therapy?
Entecavir and Tenofovir: associated with low levels of resistance (anti virals)
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)
What are the SEs of Peg-IFN?
Neuropsychiatric sx and depression
Bone marrow depression
When is HepD IgG more likely to persist
What indicates acute HepD infection? Previous exposure?
IgG **NOT PROTECTIVE
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
In the case of HCV, ___ is present with all exposures while ___ is present only in those that are viremia
What is the standard of care for HCV therapy?
Interferon-based therapy (immune activation)
Eradication rate for genotype 1? Genotype 2/3?
Eradiation rates for HCV are based on:
Undetectable virus 6 months after completion of therapy
What is the next step for a patient with high transferrin saturation?
What antibody will most likely be high in a woman with dry eyes and elevated liver enzymes with VERY HIGH ALP?
What tx is appropriate for a patient with AIH?