Viral Hepatitis II

Question 1

What is the family of Hep C? Genetic content? Enveloped?

Answer 1

Flaviviridae
+ssRNA
Enveloped

Question 2

What country has the highest incidence of Hep C?

Answer 2

Egypt

Question 3

How fast does Hep C mutate?

Answer 3

Few Years

Question 4

What disease is very closely associated with Hep C?

Answer 4

HIV

Question 5

What populations have high rates of Hep C (beside those with HIV)?

Answer 5

IV drug users

Inmates

Question 6

How does Hep C transmit in cocain?

Answer 6

Blood on straws and nosebleeds

Question 7

The highest prevalence of Hep C is in what population?

Answer 7

AA males born before 1964

Question 8

What is the average cost of a liver transplant for HCV?

Answer 8

$430,000/first year

Question 9

What is the chance of getting HCV from a blood transfusions?

Answer 9

1/10^7

Question 10

Why are clotting factors more susceptible to HCV? Getting clotting factors before what year should be suspicious for Hep C infection?

Answer 10

Clotting factors are pooled from multiple patients

1987

Question 11

Blood transfusion or organ transplant before what year have a 5-10% risk for getting Hep C?

Answer 11

1992

Question 12

What is the chance of getting Hep C from a needle stick? HIV?

Answer 12

HIV = 1/20

Hep C = 1/3

Question 13

What is the overwhelming cause of getting Hep C?

Answer 13

Injection drug use

Question 14

What happens to ALT levels in Hep C infections? Which other Hep virus does this?

Answer 14

Oscillation between normal and abnormal

No other Hep virus does this

Question 15

True or false: despite having normal LFTs, Hep C patients can develop cirrhosis

Answer 15

True

Question 16

What percent of Hep C patients will die from live cancer each year?

Answer 16

4%

Question 17

What are the four factors that are associated with fibrosis in Hep C infection?

Answer 17

Duration of infection
EtOH use >50g/day
Age >40
Male gender

Question 18

What are the ssx of acute infection with Hep C? Chronic? Advanced?

Answer 18

Acute- asymptomatic to jaundiced
Chronic = Fatigue, depression
Advanced = ssx of live rfailure

Question 19

What are the three major complications of cirrhosis caused by Hep C?

Answer 19

Hepatic encephalopathy
Portal HTN
Hepatorenal syndrome

Question 20

What are the vascular association with HCV?

Answer 20

Necrotizing vasculitis

Polyarteritis nodosa

Question 21

What happens with coinfection of Hep C and HIV?

Answer 21

Faster destruction of the liver

Question 22

What age group should be screened for hep C?

Answer 22

Baby boomers (1940–1964)

Question 23

Why is it hard to determine if a pt has Hep C?

Answer 23

LFTs can be completely normal

Question 24

What are the diagnostic tests for HCV?

Answer 24

HCV antibody
Genotyping
Liver biopsy

Question 25

What genotype is the most common HCV? What is the hardest to treat?

Answer 25

Type I most common

Question 26

What is the single most important prognostic factor for HCV infection?

Answer 26

Genotype

Question 27

What is the primary goal of HCV infection?

Answer 27

Eradicate HCV infection

Question 28

What is a sustained viral response? Is this a cure? How does this occur?

Answer 28

Sustained effect of drug against the virus. Prevents the replication of the virus. This is not a cure.

Question 29

What is pegylation? How is this effective?

Answer 29

Add a huge, inert chain of amino acids to the medication that you want. This increases the time for clearance, meaning lower doses can be used.

Question 30

What are the side effects of interferon?

Answer 30

ILI Myalgia/arthralgia Myelosuppression N/v, weight loss

Question 31

What are the two medications that appeared in 2011 that can treat HCV? Are these still used?

Answer 31

DAA (direct antiviral agents) Telaprevir and Boceprevir no longer used

Question 32

What is the MOA of Telaprevir and Boceprevir?

Answer 32

Protease inhibitors

Question 33

What is the MOA of Sofosbuvir + Ledipasvir? (3)

Answer 33

1. Block viral protease 2. Block RNA pol 3. Block Capping mechanism

Question 34

What is the treatment for HCV?

Answer 34

Sofosbuvir + Ledipasvir

Question 35

What are the side effects of Sofosbuvir + Ledipasvir?

Answer 35

Nausea

Question 36

What is the cure rate with Sofosbuvir + Ledipasvir?

Answer 36

95-99%

Question 37

HCV accounts for what percent of hepatomas in the US?

Answer 37

1/3