Term
| What is the mode of transmission of HAV? |
|
Definition
Fecal-Oral route (human reservoir):
- Close person-person contact
- Sexual contact w/ infected person
- Ingestion of contaminated food/drink |
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Term
What are the modes of transmission of HBV? |
|
Definition
Blood, semen, and body fluids
- Sexual: homosexual, heterosexual
- Parenteral: onjection drug use
- Perinatal |
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Term
| What is the mode of transmission of HCV? |
|
Definition
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Term
| What is the most common source of infection for persons w/ HCV? |
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Definition
Injecting drug use 60%
sexual 15% |
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Term
| Which type of hepatitis is self-limiting, acute viral infection, and vaccine preventable disease? |
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Definition
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Term
| In what age group shedding can occur for months following diagnosis w/ HAV? |
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Definition
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Term
| What are symptoms of HAV icteric hepatitis? |
|
Definition
| Dark urine, alcoholic (light -colored) stools, and worsening of systemic symptoms. |
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Term
| What is often a major complaint of icteric patients w/HAV? |
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Definition
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Term
| In what age group peak viral shedding of HAV precedes onset of GI symptoms? |
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Definition
| Older children and adults |
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Term
| When diagnosing HAV what two markers are present/increase? |
|
Definition
| Increased ALT and IgM anti-HAV |
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Term
| What are rare complications that could occur w/ HAV? |
|
Definition
- Relapsing hepatitis
- Cholestatic hepatitis
- Fulminant hepatitis (young children/ adult w/ chronic liver dz)
- Fatalities (rare) |
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Term
| What are methods of preventing HAV infection? |
|
Definition
- Hand hygiene
- Immunoglobulin: pre-and post exposure prophylaxis, its passive immunity
- Vaccination: Active immunity |
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Term
| T/F: Receipt of immunoglobulin (post-exposure) within 2 weeks of infection decreases infectivity and moderates infection in 85% patients? |
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Definition
| False, Pre-exposure not post-exposure will do that |
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Term
| A patient who received ≥1 dose of HAV vaccine ≥1 month prior exposure, does need to be pre-exposed w/ immunoglobulin? |
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Definition
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Term
| Who need post-exposure immunoglobulin? |
|
Definition
Recently exposed and NOT previously vaccinated:
- Close personal contact w/ HAV-infected person
- Documented infection:staff and daycare attendees
- Common source exposure (food handling)
- Classroom cantacts of infected person
- Schools, hospitals, work settings |
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Term
| Which type of hepatitis is considered DNA virus? |
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Definition
| HBV, its acute and chronic viral hepatitis |
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Term
| In which type of hepatitis does the virus attach to hepatocyte surface and viral DNA convert to circular DNA? |
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Definition
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Term
| What is the most common surface antigen in HBV? |
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Definition
| HBsAg: if positive--it indicates patient is infectious |
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Term
| Persistence of which surface Ag for> 6 months indicates chronic infection in HBV? |
|
Definition
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Term
| Which Ag present in acute infection of HBV and is BETTER than HBsAg for diagnosis of acute infection? |
|
Definition
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|
Term
|
Definition
Hepatiti B core Ag: nucleocapsid protein
Promotes immune-mediated cell death when expressed on hepatocytes
IgM anti-HBcAg present during acute infection |
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|
Term
| What serologic markers indicates that the person is acutely infected? |
|
Definition
HBsAg---positive
anti-HBc---Positive
IgM anti-HBc---Positive
anti-HBs---negative |
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|
Term
| What serologic markers indicates that the person is Chronically infected? |
|
Definition
HBsAg---positive
anti-HBc---positive
IgM anti-HBc---negative
anti-HBs---negative |
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|
Term
| What serologic markers indicates that the person aquired immunity due to HBV vaccination? |
|
Definition
HBsAg---negative
anti-HBc---negative
anti-HBs---positive |
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Term
| What serologic markers indicates that the person aquired immunity due to natural infection? |
|
Definition
HBsAg---negative
anti-HBc---positive
anti-HBs---positive |
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Term
| What serologic markers indicates that the person is HBV susceptible? |
|
Definition
HBsAg---negative
anti-HBc---negative
anti-HBs---negative |
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Term
| What are the clinical sequelae of chronic HBV infection? |
|
Definition
HBsAg--positive
HBeAg--positive
high serum titer HBV DNA ≥ 6 months |
|
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Term
| What are factors associated w/ HBV cirrhosis and disease progression? |
|
Definition
- Persistence of HBV serum DNA
- Infection w/ genotype C
- Coinfection w/ HCV, delta hepatitis, or HIV
- Age at diagnosis
- Severity of liver dz at diagnosis
- Male sex
- Frequency of severe hepatic flares
- Alcohol use
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|
|
Term
| what are types of chronic HBV? |
|
Definition
HBeAg (+)
HBeAg (-):
- Active carrier: high HBV DNA, high ALT, recurring flares, worse outcomes
- Inactive carrier: normal ALT, more benign course |
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|
Term
| What are diagnostic criteria for chronic HBV? |
|
Definition
HBsAg (+) > 6 months
Serum HBV DNA >20,000 IU/ml (10^5 copies/ml)
Persistent or intermittent elevation in ALT/AST levels
Liver biopsy showing chronic hepatitis w/ moderate or severe necroinflammation |
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Term
| When do we see lower values of serum HBV DNA, of 2000-20000 IU/ml (10^4-10^5 copies/ml) |
|
Definition
| In HBeAg (-) chronic hepatitis |
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|
Term
| What are diagnostic criteria for inative HBsAg carrier state? |
|
Definition
HBsAg (+) > 6months
HBeAg (-), anti-HBe (+)
Serum HBV DNA <2,000 IU/ml
Persistently normal ALT/AST levels
Liver biopsy confirms absence of significant hepatitis |
|
|
Term
| What are diagnostic criteria for resolved HBV? |
|
Definition
Previous known history of acute or chronic HBV or the presence of ant-HBc ± anti-HBs
HBsAg (-)
Undectable serum HBV DNA #
Normal ALT levels |
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|
Term
| What are non-pharmacologic therapy for HBV and HCV? |
|
Definition
Vaccinate household and sexual contact (HAV/HBV vaccines)
Minimize further damage to liver:
- Medications
- Alcohol:is a known risk factor for HCV progression and severity
- Smoking (HCV): may contribute to dz progression
- Obesity (HCV): known risk factor
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Term
| Monitoring for chronic HBV infection if HBeAg (+)? |
|
Definition
- If ALT <1 *ULN: Q 3-6 mo ALT, Q6-12 mo HBeAg
- If ALT 1-2 *ULN: Q 3 mo ALT, Q 6 mo HBeAg, consider biopsy if persistent or gae >40, Rx as needed
- If ALT >2 *ULN, Q 1-3 mo ALT & HBeAg, treat if persistent, liver bx optional, immediate Rx if jaundice or decompensated
HCC Surveillance indicated for all |
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|
Term
| Monitoring for chronic HBV infection if HBeAg (-)? |
|
Definition
- If ALT ≥2*ULN, & HBV DNA ≥20,000 IU/mL--treat if persistent, liver bx optional.
- If ALT 1-2*ULN, & HBV DNA 2,000-20,000 IU/mL--Q 3 mo ALT & HBV DNA, consider bx if persistent, Rx as needed
- If ALT<1*ULN, & HBV DNA<2,000 IU/mL--Q3 mo ALT *3, then Q 6-12 mo if ALT still< 1*ULN |
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Term
| Which chronic HBV treatments require dose adjustement in patients with renal dysfunction? |
|
Definition
- Lamivudine
- Adefovir
- Entecavir
- Telbivudine
- Tenofovir |
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|
Term
| Which HBV Drug has cross-resistance with adefovir? |
|
Definition
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|
Term
| Which HBV drug has cross resistance with lamivudine? |
|
Definition
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Term
| Which are the most recommended tx for chronic HBV HBeAg (+)? |
|
Definition
Peg-IFN-α: 48 weeks
Tenofovir/Entecavir≥ 1year |
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Term
| Which are the most recommended tx for chronic HBV HBeAg (-)? |
|
Definition
PEG-INF- 1 year
Entecavir/tenofovir≥ 1 year |
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|
Term
| which 2 drugs are not preferred because of resistance? |
|
Definition
| Lamivudine and telbivudine in HBeAg (-) can be used but for ≥ 1 year |
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Term
| Who are candidates for HCV screening? |
|
Definition
- Current or past use of injection drug use
- Coinfection w/ HIV
- Received blood transfusions or organ transplantations before 1992
- Received clotting factors before 1987
- Ever on chronic hemodialysis
- Pts w/ unexplained elevated ALT levels or evidence of liver dz
- Healthcare & public safety workers after an occupational exposure
- Children born to HCV(+) mothers
- Immigrants from countries w/ high prevalence of HCV infx |
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|
Term
| Why mutation occur w/ HCV? |
|
Definition
| Because lacks proofreading polymerase |
|
|
Term
| Which HCV genotype is most common? |
|
Definition
| Genotype 1: less likely to respond to tx |
|
|
Term
| What are diagnosis criteria of chronic HCV? |
|
Definition
- Detectable HCV RNA ≥ 6 months
- Physical exam: hepatomegaly
- Bx: necroinflammation dz |
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|
Term
| What is the significance of attaining early virologic response (EVR)? |
|
Definition
Patients responding early in therapy are more likely to have sustained response later.
If inadequate response early in therapy, may discontinue therapy
Note: if genotype 1 pt has EVR we continue tx for 48 weeks. If No EVR, dc tx if goal is viral eradication
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|
|
Term
| What is the standard regimen for HCV? |
|
Definition
PEG-IFN SubQ every week + Ribavirin po QD
Therapy based on genotype, weight and response to tx |
|
|
Term
| What are ADE of Ribavirin? |
|
Definition
- Drug- induced hemolytic anemia (monitor CBC)
if Hgb <10mg/dL--- dose reduction recommended
If Hgb decreases to <8.5 mg/dL--DC
- Pregnancy X (black box warning, should not even get pregnant after 6 mo of stopping med) |
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|
Term
| What are the 2 new agents for HCV tx? |
|
Definition
- Bocepravir: 800 mg po TID w/ food
ADE: anemia, neutropenia
- Telaprevir: 750 mg po TID w/ food
ADE: rash, anemia |
|
|
Term
| When are protease inhibitors indicated for chronic HCV genotype 1? |
|
Definition
As initial therapy in tx-naive pts or in pts who have failed prior IFN/Ribavirin therapy
Note: Used in combination w/ PEG-IFN and ribavirin: Not monotherapy |
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