Hepatitis I & II

Question 1

Which hepatitis viruses do not have vaccines?

Answer 1

HCV and HEV

Question 2

How many HCV infections are there in the U.S.? How many annual deaths?

Answer 2

• 3.2 million
• 20,000 (more yearly deaths than HIV)

Note: both incidence and mortality are on the rise for HCV.

Question 3

The HAV vaccine was introduced around ____________.

Answer 3

2000; as such, cases of acute HAV have precipitously dropped since then

Question 4

Both HBV and HCV have been declining since roughly _________.

Answer 4

1990, around which time blood donations started to be screened

Question 5

Give Dr. Barton’s rundown on HAV.

Answer 5

• Picornavirus
• Positive-sense, ssRNA
• Naked
• Causes acute infections
• Most often asymptomatic infection
• Vaccine is killed
• Passive immunity can be given (IV Ig), but this is not commonly used
• Diagnosed by anti-HAV IgM (for acute… anti-HAV IgG is for past exposure/immunization)
• Can only get once due to lifelong immunity

Question 6

HAV causes jaundice more commonly in ______________.

Answer 6

those older than 14

Question 7

The incubation period for HAV is _________.

Answer 7

one month

Question 8

Anti-HAV IgM is ____________ with illness.

Answer 8

concurrent, because the hepatic damage is immune-mediated

Question 9

Fulminant hepatitis occurs ___________ in HAV infections.

Answer 9

rarely (about 0.5% of cases)

Question 10

How common is HAV infection?

Answer 10

Extremely common

Almost all people in the U.S. will be exposed at some point in their lives.

Question 11

A new strain of __________ has been recently discovered that has an envelope.

Answer 11

HAV

Question 12

Give Dr. Barton’s rundown on HEV.

Answer 12

• Naked
• Icosahedral
• Positive-sense ssRNA
• Fecal-oral transmission
• Reservoir in pigs ** (Dr. Barton emphasized this) **
• Acute, self-limiting (though 10x higher mortality than HAV)
• Causes fulminant hepatitis in pregnant women
• Diagnosed by anti-HEV IgM and/or PCR

Question 13

Give Dr. Barton’s rundown on HBV.

Answer 13

• Hepadnavirus
• DNA virus
• Circular genome
• Partially ds
• Enveloped
• Acute and chronic infections
• Vaccine is to surface antigen (like the needle on the hippie van next to the blue S)
• Diagnosed by anti-HbSAg IgM, anti-HbCAg IgM
• Transmitted by blood contact (needles, birth, sex)

Question 14

HBV has _____________ in its genome.

Answer 14

overlapping open reading frames

Question 15

What happens to the HBV genome once it’s in the cell?

Answer 15

The host cell machinery “fixes” the partial dsDNA by filling in the gaps.

Question 16

HBV reverse transcriptase is active immediately prior to _________________.

Answer 16

egress of virions

Question 17

What is the incubation period of HBV?

Answer 17

Two to six months

Question 18

Acute HBV infection is more common in _____________.

Answer 18

people older than age 5

Question 19

_____________ will be absent in those who have chronic HBV.

Answer 19

Anti-HBsAg antibodies

Note: anti-HBcAg can be present in someone with chronic HBV.

Question 20

How is acute HBV treated?

Answer 20

• In an adult, no treatment is required

* In a neonate, give passive and active vaccination

Question 21

Give a rundown on HDV.

Answer 21

• Negative-sense ssRNA
• Circular genome
• Enveloped
• Requires HBV to replicate

Question 22

What is unique about HDV replication?

Answer 22

It uses host RNA polymerase II to synthesize more mRNA (which is unusual because RNA pol II usually requires DNA).

Question 23

HDV superinfection leads to ___________.

Answer 23

chronic HDV infection

Question 24

Give a rundown on HCV.

Answer 24

• Part of the Flaviviridae
• Parenteral transmission (sex, IV drug use)
• Acute infections are subclinical
• 50% – 80% of infections lead to chronic infections
• No vaccine because of antigenic variation (that is, presence of anti-HCV antibody is not protective)
• Positive-sense ssRNA
• Enveloped
• Nonsegmented
• Treated with ribavirin, interferon alpha, and sofosbuvir

Question 25

Which hepatitis virus has been shown to be transmitted by casual contact (such as toothbrushes and razors)?

Answer 25

HCV

Question 26

Sofosbuvir inhibits _______________.

Answer 26

RNA-dependent RNA polymerase (NS5B)

Question 27

What is the incubation period of HCV?

Answer 27

6 –7 weeks

Question 28

What percent of those with chronic hepatitis develop cirrhosis?

Answer 28

10%

Question 29

What genotype of HCV is most common in the U.S.?

Answer 29

1

Question 30

It’s important that patients with chronic HCV do not _______________.

Answer 30

drink alcohol; even a little can accelerate the disease process

Question 31

_________________ are now obsolete in the treatment of HCV.

Answer 31

NS3/4A protease inhibitors (such as telaprevir and boceprevir)

Question 32

The inactivated HAV vaccine generates _____________ in the host.

Answer 32

IgG

Anti-HAV IgM indicates recent infection.

Question 33

Why is it more common to have jaundice in an adult with HBV as compared to a child?

Answer 33

The hepatocellular damage is mediated by the immune system, not the virus itself. As such, the more robust adult immune system leads to a more robust symptom profile.

Question 34

What serum pattern is characteristic of chronic HBV?

Answer 34

Persistent (greater than six months) HBsAg without anti-HBsAg antibody; anti-HBcAg can be present

Question 35

All of the -previr drugs target __________.

Answer 35

HCV protease

Question 36

In general, the acute phase of __________ is more mild than HBV.

Answer 36

HCV

Question 37

How long are anti-virals given to those with chronic HBV?

Answer 37

Up to one year