Hepatitis and Hep Treatment

Question 1

Most common viral hep worldwide?

Answer 1

Hep A

Question 2

Spread of hep A?

Answer 2

Fecal-oral

Question 3

Does hep A have a vaccine?

Answer 3

yes

Question 4

Life of hep A

Answer 4

acute, benign, self limited (<2mo)

Question 5

How is hep B transmitted?

Answer 5

Perinatal, blood, sex IVdrugs

Question 6

How does hep B look in adults?

Answer 6

Unlikely to be chronic

Question 7

How does hep B look in kids

Answer 7

almost always chronic

Question 8

Serologies if vaccinated for hep B

Answer 8

+surface Ab only (only there if cured or immunized)

Question 9

Serologies if have chronic for hep B

Answer 9

+surface Ag
+surface core IgG
elevated DNA

Question 10

Serologies if acute for hep B

Answer 10

+surface Ag
+core (IgM or IgG)
elevated DNA

Question 11

What is the only DNA hep virus?

Answer 11

Hep B….stable DNA so harder to treat

Question 12

How do you treat hep B

Answer 12

Interferon

Question 13

How do you treat babies whos moms have hep B

Answer 13

vaccine at birth

Question 14

What is e antigen?

Answer 14

e antigen is secreted only if virus is replicating. Indicates active virus

Question 15

What is e antibody

Answer 15

e antibody indicates robust immune response dec virus

Question 16

What does the most injury to liver in hep B?

Answer 16

immune response

Question 17

What will your labs look like with immune tolerance to hep B?

Answer 17

• no ALT
• High DNA
• eAg pos/eAb neg
• ->typical initial phase of perinatal acquired infection

Question 18

What will your labs look like with chronic hep

Answer 18

• ALT high
• High DNA
• eAgpos/eABneg

Question 19

What will your labs look like with seroconversion to inactive carrier state?

Answer 19

ALT transient inc then nl

Low DNA

eAg neg/eAb pos

Question 20

eAg and chronic hep

Answer 20

can be neg or pos

Question 21

What are the indications for HBV treatment?

Answer 21

• elevated ALT
• elevated HBV DNA
• cirrhosis and detectable HBV dna

Question 22

What are the goals of HBV therapy

Answer 22

• dec risk of hepatic decompensation and HCC
• Normalization of ALT
• Histological improvement

Question 23

How do most of the HBV drugs work?

Answer 23

Viral polymerase inhibitors, oral or interferon

Question 24

What is special about eAg negative patients regarding therapy?

Answer 24

They relapse when you go off interferon therapy

Question 25

What are some advantages to interferon therapy?

Answer 25

- no viral resistance (immune activator, doesn't work on virus) - Finite course of therapy

Question 26

What are some disadvantages of interferon?

Answer 26

- Not great with high HBV DNA and low ALT - Side effects - Cant use with decompensated liver dis - High relapse with eAg neg

Question 27

In what setting would you see hep D?

Answer 27

Only in setting of hep B infection

Question 28

What does hep D inc risk of?

Answer 28

Fulminant liver

Question 29

How is hep D spread?

Answer 29

percutaneously

Question 30

What kind of virus is hep C

Answer 30

RNA

Question 31

Does genotype of hep C impact severity?

Answer 31

No, but it impacts treatment response

Question 32

What constitutes decompensated cirrhosis?

Answer 32

- ascites - HE - Jaundice - Variceal bleeding

Question 33

Who is more likely to have hep C M or F?

Answer 33

M

Question 34

What is the gold standard for treatment of hep c?

Answer 34

Sustained viral response (SVR) | -absence of detectable HCV in blood 6 mo after end of therapy

Question 35

What is the chance of relapse after SVR is reached?

Answer 35

<1%

Question 36

What are the two treatments for hep c?

Answer 36

Pegylated interferon alpha (IV) and ribavirin (oral)

Question 37

What are the adverse events of interferon?

Answer 37

- flu - like symp - depression - pancytopenia (bone marrow supp) - immune disease activation - wt loss - infection - worsening of cirrhosis

Question 38

How should ribavirin be administered

Answer 38

INEFFECTIVE as monotherapy! Use with interferon

Question 39

What are the adverse events of ribavirin?

Answer 39

- non-immune hemolytic anemia - rash - dyspnea (difficulty breathing) - teratogenic - contraindicated in chronic renal failure

Question 40

On old treatment, what was predictive of drug's success?

Answer 40

Rapid decline of viral laod inc likelihood of SVR

Question 41

Can you use monotherapy for hep C drugs?

Answer 41

NO! virus will rebound

Question 42

What are DAA agents?

Answer 42

Target more specific pathways in virus. Can be used for one strain or all. end in -vir

Question 43

Describe the peaks in hep C life cycle

Answer 43

- inc HCV then dec - Inc ALT after HCV hits peak - Inc anti-HCV at around wk 10

Question 44

What % hep is responsive to therapy?

Answer 44

85-95%

Question 45

What kind of virus is hep E?

Answer 45

RNA

Question 46

What is special about hep E worldwide?

Answer 46

most common cause of epidemic enterically transmitted hep

Question 47

How is hep E transmitted?

Answer 47

Fecal-Oral, immunosuppressed

Question 48

Who is hep E most dangerous for

Answer 48

pregnant women are at higher risk for fulminant hep

Question 49

What rises quickly in hep E?

Answer 49

ALT rises with IgM

Question 50

What hep is most likely to give you fulminant hep?

Answer 50

hep D

Question 51

Which heps give you chronic infections?

Answer 51

hep B in infants mostly and hep C and hep D superinfection (ie get hep D after already had hep B)