Viral Hepatitis

Question 1

Where is there a high prevalence of hepatitis infections (3)

Answer 1

South America
Africa
South East Asia

Question 2

How soon after infection does hepatitis A infection become symptomatic

Answer 2

2-6 weeks

Often subclinical

Question 3

How is hepatitis A spread

Answer 3

Faeco-oral spread

Question 4

Is hepatitis A a notifiable disease

Answer 4

Yes

Question 5

What occurs during a hepatitis A infection (3)

Answer 5

Raised ALT
HAV in stool
IgM

Question 6

What is left after the hepatitis A virus is cleared

Answer 6

IgG

Question 7

Anti-HAV IgM

Answer 7

Recent infection (or vaccine)

Question 8

Anti-HAV-IgG

Answer 8

Recent infection (or vaccine)

Question 9

Where are HBeAg found

Answer 9

In the core of the virus

Question 10

Where are HBsAg found

Answer 10

Viral envelope

Question 11

How is hepatitis B spread (3)

Answer 11

Sexual
Vertical transmission
Blood products

Question 12

How does hepB present (2)

Answer 12

Acute

Chronic

Question 13

What is chronic hepB

Answer 13

Infection present for >6 months

Question 14

What is present in the serum in chronic hepB infection (4)

Answer 14

Anti-HBc
Anti-HBs
Anti-HBe
Anti-HBc IgM

Question 15

What are the long term consequences of hepatitis B infection (3)

Answer 15

Hepatic fibrosis
Cirrhosis of the liver
Liver cancer

Question 16

What are the HBV disease stages (5)

Answer 16

Immune tolerant 
Immune reactive 
Inactive HBV carrier state 
HBeAg negative chronic HBV
HBsAg negative phase

Question 17

What did the REVEAL study discover related to HBV infection (2)

Answer 17

Increased incidence of cirrhosis with increasing baseline serum HBV DNA level
Increased incidence of HCC with increasing HBV DNA baseline viral level

Question 18

What drugs are used to treat chronic HBV (6)

Answer 18

Interferon alpha 
Lamiduvine 
Adefovir
Tenofovir
Entacavir
Emtricitabile

Question 19

What family of viruses does HCV belong to

Answer 19

Flaviviridae

Question 20

How is HCV spread

Answer 20

Mainly blood product spread

Question 21

What proportion of HCV infections are chronic

Answer 21

60-80%

Question 22

What are the two possible outcomes of acute hepatitis C infection (2)

Answer 22

Clears 20-40%

Chronic 60-80%

Question 23

What is the serology in acute HCV (2)

Answer 23

Sharp spike in ALT

Followed by rise in anti-HCV

Question 24

What are the long term effects of HCV infection on the liver (3)

Answer 24

Hepatic fibrosis
Cirrhosis
Liver cancer (HCC)

Question 25

What are the treatment targets for chronic HCV infection (3)

Answer 25

``` NS3/4 serine protease, RNA helicase. NS5A RNA(unknown action) NS5B RNA dependent RNA polymerase ```

Question 26

What are some drugs used to target NS3/4 serine protease in hepatitis C (3)

Answer 26

Teleprevir Boceprevir SImeprevir

Question 27

What are somedrugs used to target NS5A RNA in hepatitis C (3)

Answer 27

Ledipasvir Daclatasvir Elbasvir

Question 28

What drugs are used to target NS5B RNA dependent RNA polymerase in hepatitis C infection (3)

Answer 28

Sofosbuvir Dasabuvir Beclabuvir

Question 29

What rises acutely following hepatitis D infection (3)

Answer 29

IgM anti-HDV HDV RNA HBsAg

Question 30

What is present after HDV infection

Answer 30

Anti-HBs

Question 31

What is required for HDV infection

Answer 31

HBV infection

Question 32

What family does HEV belong to

Answer 32

Hepeviradae

Question 33

Where is HEV present (2)

Answer 33

SE Asia | Africa

Question 34

What are the different HEV genotypes (2)

Answer 34

Genotypes 1 and 2 - human, epidemic | Genotype 3 and 4 - swine and other (humans accidental hose = zoonosis)

Question 35

Can HEV be transmitted person-person

Answer 35

Very rarely

Question 36

What is the incubation period for HEV

Answer 36

3-8 weeks

Question 37

What is a danger of HEV in pregnancy

Answer 37

Genotype 1 has a high mortality in pregnancy

Question 38

What are some rare complications of HEV (4)

Answer 38

CNS disease - Bell's palsy, Guillain Barre, other neuropathy Chronic infection

Question 39

What is the treatment for HEV (2)

Answer 39

Supportive | Ribavirin

Question 40

Is there a vaccine for HEV

Answer 40

Yes - trials with recombinant HEVg1 in Nepalese military and Chinese

Question 41

How is HEV detected

Answer 41

HEV antigen becomes detectable in stool and serum during the incubation period

Question 42

What is present in the late stages of HEV infection (2)

Answer 42

IgG anti-HEV antibody | IgM ant-HEV antibody

Question 43

What is an effective HCV treatment

Answer 43

Peginterferon combination therapy is the best