Viral Hepatitis: Nair

Question 1

3 clinical presentations of viral hepatitis:

Answer 1

Acute hepatitis
Fulminant liver failure
Chronic hepatitis

Question 2

3 complications of chronic hepatitis:

Answer 2

Cirrhosis (20-30 yrs of chronic hepatitis)
Liver failure
Hepatocellular carcinoma

Question 3

Which form(s) of hepatitis (A-E) can end resolution w/o treatment?

Answer 3

A and E

Question 4

Which form(s) of hepatitis (A-E) can lead to chronic hepatitis?

Answer 4

B, C, D (further down alphabet, more protracted course)

Question 5

Which form(s) of hepatitis (A-E) can lead to acute hepatitis?

Answer 5

A, B, C, E
only HDV only leads to chronic
HCV is USUALLY chronic (think: C = chronic, A = acute, B = both)

Question 6

IV drug users have:

Answer 6

HCV

Question 7

Healthcare worker gets stuck w/ a needle and 2 weeks later has hepatitis, they have:

Answer 7

HCV

Question 8

Not stuck by needle, but have acute Hep? You have:

Answer 8

HAV or HBV

Question 9

Labs for acute hepatitis:

Answer 9

High AST/ALT- >1000IU/L
High bilirubin, PT/INR
Very high INR (>4) may inducate progression to fulminant hepatic failure

Question 10

Your pt is infected at week 0. Describe the clinical course of acute hepatitis in terms of illness and rise and fall of liver enzymes, IgG, IgM from week 0 to week 13.

Answer 10

Enzymes and IgM peak at week 4 and 6, respectively. 
IgM drops after wk 6 steadily. 
IgG rises slowly over entire course. 
Enzymes back to normal by week 9. 
Clinical illness lasts from weeks 2-8.

Question 11

Most common outcome of HAV and HBV?

Answer 11

Spontaneous resolution.

Question 12

Most common outcome of HCV?

Answer 12

Chronic infection.

Question 13

How do you dx acute hepatitis?

Answer 13

Ab titers for IgM anti HAV, HBV, HEV

Question 14

What does the presence of IgG?

Answer 14

Prior infection. Either resolved or active chronic.

Question 15

What does the presence of viral RNA or DNA show?

Answer 15

Active infection, but does not differentiation btwn acute or chronic.

Question 16

Which viral cause of hepatitis is the only one that is a DNA virus (A-E)?

Answer 16

HBV

Question 17

A dx of chronic hepatitis can be made using several lab/clinical findings, including ALT/AST levels how many times the normal (~19-25)?

Question 18

Presence of a positive titer for HBsAg (HBV surface antigen) means:

Answer 18

Active infection w/ HBV (either acute or chronic)

It is the most important test!

Question 19

When do you treat chronic HBV?

Answer 19

When there is evidence of liver injury (high ALT) or advanced liver fibrosis

Question 20

How do we tx HBV?

Answer 20

Entecavir- long duration of tx, targets HBV replication

Tenofovir

Question 21

HDV is unique in that it requires what to infect its host?

What is the big deal w/ HDV?

Answer 21

Host must have HB surface antigen, meaning prior infection w/ HBV.
::HDV increases severity of HBV infection and increases risk of cirrhosis.

Question 22

Which viral cause of hepatitis can be cured?
Why can it be cured, compared to the others?
What is this magical cure?

Answer 22

HCV (C=cure, chronic)
Cure is attributable to fact that HCV never enters nucleus of host cell. Drugs can reach it in the cytoplasm.
Tx: Sofosbuvir (NS5B polymerase inhibitor) + Ledispavir (NS5A poly. inh.) HARVONI- trade name. Tx for Genotype 1, MC genotype in US.
No major side effects.

Question 23

_______ is now the leading cause of death in HIV pts.

Answer 23

HCV

Question 24

Many HIV drugs (Tenofovir) have co-activity in treating this viral cause of hepatitis:

Answer 24

HBV

Question 25

Describe some strongly associated extrahepatic manifestations of HCV/HBV.

Answer 25

Mixed cryoglobulinemia
Sjogren syndrome
Lymphoproliferative disorders
Porphyria
Neuropathy
Membranoproliferative glomerulonephritis
Cryoglobulinemic vasculitis

Question 26

List other viral sources of hepatitis.
List lab values.
Self-limiting or nah?

Answer 26

:: CMV- transplant pts. Prophylaxis w/ valcyclovir. tx: ganciclovir.
:: Epstein-Barr
:: Herpes

ALT/AST 300-600 IU/L

Self-limiting, except in immunocompromised.