Hepatitis

Question 1

Treatment of Chronic HBV

Answer 1

(pegylated) IFN

Lamivudine (RT inhibitor)

Adefovir (dATP analog)

Entacavir (guanine analog)

Question 2

Standard treatment for HCV genotype 1

Answer 2

Pegylated Interferon + Ribavirin + Protease Inhibitor

Question 3

Protease Inhibitors (2) used in “Triple Therapy” vs. HCV genotype 1

Answer 3

Teleprevir
Boceprevir

Target NS3/4A protease

Question 4

Sofosbuvir

Answer 4

Direct-acting antiviral for treatment of HCV

Targets NS5B RNA-dependent RNA polymerase

Question 5

Ledipasvir

Answer 5

DAA for HCV treatment

NS3/4A protease inhibitor

Question 6

Harvoni

Answer 6

Combination of sofosbuvir (RdRP inhibitor) and Ledipasvir (protease inhibitor)

1 pill per day cures HCV in 8 - 12 weeks

Question 7

HCV Protease NS3 inhibitors

Answer 7

Telepravir
Boceprevir
Paritaprevir

Question 8

HCV NS5B RdRP inhibitors

Answer 8

Sofosbuvir

Dasabuvir

Question 9

HCV NS5A Proteas Inhibitors

Answer 9

Ledipasvir

Ombitasvir

Question 10

Viekira Pak

Answer 10

Combo pill Ombitasvir + Paritaprevir + Ritonavir dosed once daily

+ Dasabuvir dosed once daily

Cures HCV infections in 12 weeks

Two pills daily

Question 11

General symptoms of acute hepatitis

Answer 11

Nausea 
Vomiting 
Decreased appetite 
Fever
Diarrhea 
Clay-colored stools 
Dark urine 
Jaundice

Question 12

HAV - Virology & Presentation

Answer 12

Picornavirus (+ssRNA, naked)

Spread by fecal-oral transmission via contaminated sea food and produce

Acute disease only; symptoms are mild-moderate and self-resolve over 2-6 months

Question 13

Diagnosis of HAV

Answer 13

HAVAg - detectable in stool early in infection; marker of infectivity

Anti-HAV (IgM) - marker of recent ( < 6 month) infection

Anti-HAV (IgG) - marker of previous exposure / vaccination

Question 14

HAV Prevention

Answer 14

Killed virus vaccine from capsid protein; only one serotype exists and so vaccine is universally efficacious and recommended for all children in the US

Anti-HAV IVIG can be given for PEP

Question 15

HEV - Virology & Presentation

Answer 15

RNA Hepeviridae family; +ssRNA, naked

Transmitted fecal-oral by contaminated water

Causes acute infection only; similar to HAV but more severe especially in pregnant women (mortality = 40%)

Question 16

HBV - Virology and Presentation

Answer 16

DNA Hepadnavirus

Transmitted by infected blood, sexual contact, and from mother to infant

90% are asymptomatic and cleared by host immune response; 10% progress to chronic infection with mild, periodic inflammation associated with increased risk of HCC

Question 17

HBV Prevention

Answer 17

Routine vaccination

Vaccination of infants born to HBV+ mothers immediately at the time of birth

Question 18

HDV

Answer 18

Defective virus; consists of circular -ssRNA encoding a delta antigen; occurs with HBV as co-infection (concurrent) or super-infection (afterwards)

Co-infection with HBV increases disease severity; HDV persists and becomes chronic along with HBV

HBV vaccination also prevents HDV

Question 19

HCV - Virology

Answer 19

Flaviviridae family (+ssRNA); 7 genotypes exist with genotypes 1a and 1b the most common in the US

Long polypeptide is processed to produce: 
E1 and E2 (envelope glycoproteins ) 
C (capsid protein) 
NS2 (protease) 
NS3 (protease / helicase) 
NS5B (RNA-dependent RNA polymerase)

Question 20

HCV - Clinical features

Answer 20

Acute infection - after 6/7 weeks incubation, occurs asymptomatically or presents with mild anorexia, malaise, abdominal pain, jaundice; 10% resolve without sequelae

Chronic phase - 80-90% progress over the course of years asymptomatically or with mild, non-specific, intermittent symptoms (fatigue, RUQ discomfort, nausea) +/- signs of cirrhosis

20-30% develop cirrhosis
1-5% of these develop HCC

Question 21

HCV - Diagnosis

Answer 21

ELISA for anti-HCV Ab used for screening but not able to distinguish acute vs. chronic or active vs. cleared

RT-PCR detects virus in blood