115b Clinical Viral Hepatitis

Question 1

HBV vaccine is made of what antigen?

Answer 1

HBs

Question 2

which hep viruses have vaccines? should we vaccinate in shit holes?

Answer 2

A and B –> dramatic decrease in US.
Hep A still big in south america, africa, india - don’t vaccinate in these areas b/c everyone gets it when young and is thus low risk

Question 3

Hep A

1) Genetic material and virus type
2) transmission
3) carriers?
4) incubation
5) HCC risk?
6) symptoms
7) treatment
8) Notes

Answer 3

1) Genetic material and virus type
SS+ RNA; picornavirus
2) transmission
Fecal-oral (like Hep E) --> resilient b/c no membrane
3) carriers?
No
4) incubation
Short - weeks
5) HCC risk?
No
6) Symptoms
Jaundice, fever, fatigue, 
7) Treatment
supportive
8) Notes (4 A's)
Asymptomatic (children usually; adults get sick)
Acute (IgM for acute infection, IgG previous/vaccine)
Alone (no carriers)
Ain't going to hurt (not cytopathic by itself)

Question 4

which hep viruses are not cytopathic?

Answer 4

Hep A
Hep B
Hep E

Question 5

Hep B

1) Genetic material and virus type
2) transmission
3) carriers?
4) incubation
5) HCC risk?
6) symptoms
7) treatment
8) Notes

Answer 5

1) Genetic material and virus type
DNA; hepadnavirus 
2) transmission
parenteral, sexual, maternal-fetal
3) carriers?
Yes (kids)
4) incubation
long (months)
5) HCC risk?
Yes - integrates into genome (oncogene)
6) symptoms
7) treatment - oral antivirals or interferon 
8) Notes
-Babies become carriers; adults with acute hepatitis are clearing virus so don't usually treat
-own dna poly to finish d/s dna then uses host rna poly
-overlapping reading frame genome

Question 6

HBsAg

Anti-HBs

Answer 6

Surface antigen - indicates Hep B infection (acute and chronic); may be negative during window period; doesn’t indicate active replication

indicates immunitiy

**both negative during window period so check Anti-HBc

Question 7

HBeAg

Answer 7

from pre-core portion of gene

indicates active viral replication and transmissiblity

Question 8

Chronic Hep B length and phases

Answer 8

Occurs over decades
1- immune tolerance - virus replicates (high DNA); ignored by immune system (normal LFTs)
2- Immune reactive/clearance - hepatitis presentation due to immune system; seroconversion may occur –> carrier
3- Inactive carrier - low DNA, normal LFTs; some may lose HBsAg with gain of HBsAb (recovery)

Question 9

seroconversion

Answer 9

loss of HBeAg and gain of AHeAb –> carrier

Question 10

Angi-HBc - IgM vs IgG

Answer 10

IgM - acute infection
IgG - chronic/prior exposure
+ during windown period

Question 11

Acute HBV serum markers

Answer 11

+ HBsAg
+ HBeAg
IgM Anti-HBc

Question 12

immunized HBV serum markers

Answer 12

Anti-HBs only

Question 13

recovered HBV serum markers

Answer 13

+Anti-HBs
+Anti-HBe
+Anti-HBc IgG

Question 14

Hep B treatment

Answer 14

1) oral antivirals (“_vir”) - won’t clear but limits replication
2) interferon - helps stimulate immune system so can clear but not tolerated; can worse liver damage

Question 15

Hep C

1) Genetic material and virus type
2) transmission
3) carriers?
4) incubation
5) HCC risk?
6) symptoms
7) treatment
8) Notes

Answer 15

Hep C
1) Genetic material and virus type
\+SS RNA; flavivirus
2) transmission
Blood, IVDU, transfusion
3) carriers?
Yes
4) incubation
long
5) HCC risk?
yes - chronic inflammation
6) symptoms
Hep C
7) treatment
protease inhibitors ("_vir")
RdRp inhibiros/NS5A inhbiitors 
8) Notes
Chronic
Cirrhosis
Carcinoma
Carrier
Can't vaccinate (RNA poly error prone)
Continuos polyprotein

Question 16

what does Hep D need?

Answer 16

HBsAg for outside coat

oral antivirals won’t stop Hep D virus from spreading b/c HBsAg still made