Flashcards in L76 (Hep C, A, E) Deck (34):
1
Hep C genome
+ ss RNA
LARGE
Genotypes 1-7
2
What are the 3 Hep C drug targets?
Non-structural proteins - disable these, disable viral fxn
NS -34A = Protease
NS-5B = RNA pol
NS-5A = critical for viral replication
3
Hep C transmission
Blood - IVDU!!!
Sex
Perinatal
4
Hep C receptor on liver cells
CD81
Shows liver tropism
5
Where does Hep C replicate in host cells?
Cytoplasm - ER
6
Can Hep C go chronic?
Yepppp
Cirrhosis or cancer
7
Most common US genotype
1a
8
Diagnose Hep C
1. ELISA for Ab - more a rule out test
Follow up with
2. PCR for RNA (viral load)
9
Which is more likely to resolve in acute on own: Hep C or B?
B more likely to resolve as acute
C - chronic
10
What is the difference between Hep C and B cancer risk?
C chronic more stable
B you're worried about a switch flip to cancer
11
Who do you treat for Hep C
Fibrosis stage 2+
Need to make sure will be treatment compliant
12
Treat Hep C
A CURE!!!
DAAs = direct acting anti-virals = target non-structural genes
2 DAA =
- Harvoni
- Veikira
13
Hep C grade vs stage
Determined by biopsy
Grade = amt liver inflam
Stage = amt of fibrosis
14
Hep C treatment issues
$$$
Resistance
- Fail NS5A regimen, don't have great alternatives
15
What is unique about genotype 3 treatment?
Doesn't respond great to DAAs
Better on IFN, but we don't use this anymore due to toxicities
16
Define Hep C cured
No viral load for 3-6 mos
17
Why can't you cure HIV or Hep B?
B/c genetic elements persist in the nucleus
HIV - integrates into host DNA
HBV - cccDNA
18
What is Harvoni
Ledipasvir + Sofosbuvir
Ledi = X NS5A (critical for rep)
Sofo = X RNA pol
19
What is Veikira
Protease inhibitor +
NS5A inhibitor +
Non-nucleoside NS5B inhibitor
20
Hep A genome
+ssRNA
Picorna - acute viral hepatitis
21
Hep A transmission
Food/water contaminated by feces (Seafood)
Oral --> GI --> blood --> liver
Replicates in liver --> released in bile = infectious feces
22
Can Hep A go chronic?
Nope
23
Treat Hep A
Supportive
24
Hep A vaccine
1. Passive IG - travelers
2. Active vaccine
25
Hep E genome
+ssRNA
Naked
26
Hep E genotypes
1 & 2 = human host
3 & 4 = pig host, human accident
27
Who are you worried about getting a genotype 1 or 2 Hep E infection? Transmission.
Will infect pregnant women!!!
- HIGH mortality :(
Fecal-oral/water transmission
28
Unique characteristics of Hep E genotypes 3 & 4
Food borne (pork)
Neuro complications
29
Treat Hep E
Supportive
30
Which hep strains can cause fulimnant liver failure?
A
B
E in pregnant women
31
Which hep strains can become chronic?
C !!!
B - newborns
E - transplant pts
32
Which hep strains will resolve?
A
E
Most B
Some C - likely not
33
Which hep strains have active and passive vaccines?
A
B
34