MICRO: Hepatitis

Question 1

Which hepatitis viruses are non-enveloped?

Answer 1

HAV and HEV

Question 2

Who is most affected by HAV?

Answer 2

Adults are 70% symptomatic

Children often subclinical (10%)

Question 3

Do antibodies appear before of after infection in HAV?

Answer 3

With rising ATL, IgM rises

Question 4

What tests are done to diagnose HBV?

Answer 4

HBsAg
HBcAb
HBsAb

Question 5

What test is used to diagnose HCV?

Answer 5

HCV RNA (antibodies develop late)

Question 6

What test is used to diagnose HDV?

Answer 6

Anti-HDV serology

Question 7

How many genotypes of HBV?

Answer 7

10 (A-J)

Question 8

A Dane particle is characteristic of which infection?

Answer 8

HBV

Question 9

How long does HBV need to last to be chronic?

Answer 9

6 months

Question 10

What infection despite being asymptomatic in children has long term consequences?

Answer 10

HBV - 90% of infected neonates develop chronic HBV

Question 11

What % of adults with HBV develop chronic infection?

Answer 11

10%

Question 12

Why is testing for HBsAb not useful in acute infection?

Answer 12

Only appears later - but HBcAb is present early (IgM type)

Question 13

Why can you not use IgM anti-HBc to diagnose acute infection in HBV?

Answer 13

It could also mean chronic infection

Question 14

What are the 2 stages of HBV infection?

Answer 14

HBeAg +ve or -ve

Question 15

What are the 2 stages of HBV infection?

Answer 15

HBeAg +ve or -ve

Question 16

Why is testing of HBV DNA levels helpful?

Answer 16

Increasing levels mean higher risk of HCC and cirrhosis (REVEAL study)

Question 17

What is the main treatment for HBV?

Answer 17

Interferon-alpha or antivirals (ETV, TDF,TAF)

Question 18

If mother is ANTI-HBeAg positive, does the baby need to receive HBIG?

Answer 18

No, only vaccination

Question 19

What antibody protects from HBV?

Answer 19

Anti-HBsAg

Question 20

What % of HCV becomes chronic?

Answer 20

70% (higher in males)

Question 21

What is the tx for HCV?

Answer 21

Peginterferon alpha 2b + ribavirin –> 90% cure rate

Question 22

What is SVR12?

Answer 22

If at 12 weeks after stopping treatment the virus is gone then you are cured

Question 23

What is the significance of different genotypes in HCV?

Answer 23

Genotype 1 is harder to treat than non-1

Question 24

What is the significance of different genotypes in HCV?

Answer 24

Genotype 1 is harder to treat than non-1

Question 25

What DAA targets are used in HCV?

Answer 25

non-structural proteins 3/4, 5a and 5b

Question 26

What is NS3/4 the target of ?

Answer 26

Protease inhibitors - "previr"

Question 27

What is NS5a the target of?

Answer 27

NS5a inhibitors - "asvir"

Question 28

What is NS5b the target of?

Answer 28

NS5B inhibitors (RNA polymerase inhibitors) - "buvir"

Question 29

What is the disadvantage of NS3/4 protease inhibitors over the others?

Answer 29

Only for Genotype 1, low barrier to resistnce and interactions

Question 30

Which NS targetting drugs target all cellular processes in HCV (processing, replication, assembly)?

Answer 30

NS5a inhibitors - "asvir"

Question 31

Which NS targeting drugs target all cellular processes in HCV (processing, replication, assembly)?

Answer 31

NS5a inhibitors - "asvir"

Question 32

What is it called when you have HBV but then get HDV too?

Answer 32

Superinfection

Question 33

Is HBV-HDV co-infection or superinfection more serious?

Answer 33

Superinfection - 80% risk of c hronic infection

Question 34

What are the genotypes of HEV?

Answer 34

G1 + 2 = obligate human pathogens | G3 + 4 = zoonotic (i.e. must have come from an animal)

Question 35

UK is endemic of which HEV genotype?

Answer 35

Genotype 3

Question 36

Which population is most at risk of HEV?

Answer 36

Pregnant women --> fulminant hepatitis

Question 37

What are some CNS complications of HEV?

Answer 37

Bell's palsy GBS Also has haem, renal, cardiac, bone, thyroid and pancreas complications. Case reports only for some.

Question 38

Which hepatitis virus is associated with MSM?

Answer 38

HAV

Question 39

Which hepatitis virus is associated with shellfish and sausage consumption?

Answer 39

HEV

Question 40

How is HEV diagnosed?

Answer 40

Anti-HEV serology (anti-HEV IgM rises acutely)

Question 41

How is HEV diagnosed in the immunocompromised?

Answer 41

HEV PCR

Question 42

Where can HEV persist for longer?

Answer 42

Stools

Question 43

Which hepatitis virus would chef's not be allowed to prepare food for a few weeks?

Answer 43

HEV