Hepatitis

Question 1

Hepatitis A virus:

• DNA/RNA
• Family
• Transmission

Answer 1

• RNA
• Picornavavirus
• Fecal-Oral

Question 2

Who does HAV primarily effect?

Answer 2

Children, often before 11 y/o

Question 3

Diagnosis of Acute infection depends on demonstrating what?

Answer 3

IgM anti-HAV

Question 4

IgG anti-HAV indicates.

Answer 4

Acute or past infection

-persists for life

Question 5

Hepatitis B virus:

• DNA/RNA
• Family
• Name of intact virion

Answer 5

• DNA
• Hepdnavirus
• Dane particle

Question 6

HBV viral markers:

-HbsAg (surface antigen)

Answer 6

Indicates Active disease

-either acute infection or chronic carrier state

Question 7

HBV viral markers:

-HBeAg (when is it produced?)

Answer 7

-Indicates chronic carriage with active viral replication

only produced when the virus in in replicating form

Question 8

HBV viral markers:

• Anti-HBc (antibody to B core antigen)
• IgM
• Total antibodies (IgG/IgM)

Answer 8

• Present throughout lifetime of someone who has been INFECTED
• Acute infection
• Acute and Past infection

Question 9

HBV viral markers:

-Anti-HBe (3)

Answer 9

• Found when HBe becomes negative
• Does NOT imply resolved infection or immunity
• Indicates chronic carrier without active viral replication

Question 10

HBV viral markers:

-HBsAb (antibody vs surface antigen)

Answer 10

• Indicates resistance from infection

- Found in IMMUNIZED persons and those who have successfully cleared HBV infection

Question 11

When do serologic markers for HBV emerge?

Answer 11

2-10 weeks following infection

Question 12

What marker appears 1st following HBV infection; followed by which ones?

Answer 12

• HBsAg
• HBeAg
• IgM anti-HBc

Question 13

T/F: HBV DNA is detectable in serum before HBsAg.

Answer 13

True

Question 14

What serologic markers coincide with emergence of symptoms?

Answer 14

-Anti-HBc

Question 15

What antibodies emerge when there is complete resolution of acute HBV infection?

Answer 15

• Anti-HBe

- Anti-HBs

Question 16

What remains positive in patients who develop chronic HBV infection? (what is criteria for diagnosis)

Answer 16

HBsAg remains positive

-persistence for >6months

Question 17

Persistent HBsAg without clinical hepatitis is called what

Answer 17

-Chronic Carrier State

Question 18

Chronicity develops in % of:

• Healthy
• Immunocompromised adults
• Neonates infected transplacentally

Answer 18

• 5%
• 10%
• 90%

Question 19

What is chronic HBs antigenemia associated with?

Answer 19

Polyarteritis Nodosum (PAD)

Question 20

Which Hepatitis virus can only infect hepatocytes with HBV DNA?

Answer 20

HepD (HDV)

Question 21

HBeAg - Chronic Hepatitis B is characterized by what? *3)

Answer 21

• Circulating HBV DNA
• Fluctuating aminotransferases
• Tendency towards fulminant hepatitis with liver failure

Question 22

HBeAg - Chronic Hepatitis B results from what?

Answer 22

Mutations in the C or pre C region of the HBV genome in which a premature stop codon impairs synthesis of HBeAg

Question 23

What are the 3 major applications for molecular assays in HBV?

Answer 23

• Making initial diagnosis of HBV
• Replicative vs. Nonreplicative Chronic HBV
• Response to therapy (undetectable HBV DNA is consiered a virologic response)

Question 24

Those with ____ copies of HBV DNA/mL are considered replicative chronic HBV.

Answer 24

> 10^5 copies of HBV DNA

Question 25

HBV Serology - No prior infection nor immunization: - HBsAg - Anti-HBc - Anti-HBs

Answer 25

HBV Serology - No prior infection nor immunization: - HBsAg - Neg. - Anti-HBc - Neg. - Anti-HBs - Neg.

Question 26

HBV Serology - Prior immunization: - HBsAg - Anti-HBc - Anti-HBs

Answer 26

HBV Serology - Prior immunization: - HBsAg - Neg. - Anti-HBc - Neg. - Anti-HBs - Positive

Question 27

HBV Serology - Acute HBV: - HBsAg - Anti-HBc - Anti-HBs

Answer 27

HBV Serology - Acute HBV: - HBsAg - Positive - Anti-HBc - Positive (IgM) - Anti-HBs - Neg.

Question 28

HBV Serology - Chronic HBV: - HBsAg - Anti-HBc - Anti-HBs

Answer 28

HBV Serology - Chronic HBV: - HBsAg - Positive - Anti-HBc - Positive - Anti-HBs - Negative

Question 29

HBV Serology - Resolved HBV: - HBsAg - Anti-HBc - Anti-HBs

Answer 29

HBV Serology - Resolved HBV: - HBsAg - Neg. - Anti-HBc - Positive (IgM&IgG) - Anti-HBs - Positive

Question 30

Hepatitis C virus family.

Answer 30

Flavivirus

Question 31

What is the most common cause of transfusion associated viral hepatitis?

Answer 31

HepC

Question 32

What percentage of those infected develop chronic HCV?

Answer 32

60%

Question 33

What percentage of those with chronic HCV develop cirrhosis?

Answer 33

15%

Question 34

What percentage of those with cirrhosis develop HCC?

Answer 34

5%

Question 35

What are the extrahepatic manifestations of HCV? (3)

Answer 35

- Mixed cryoglobulinemia - Glomerulonephritis - Aplastic anemia

Question 36

Diagnosis of HCV is based on which 3 assays?

Answer 36

- EIA based assays for anti-HCV antibodies - HCV RNA - Recombinant Immunoblot Assay (RIBA)

Question 37

HCV Assay results - Early HCV infection (<3 months): - Anti-HCV (EIA) - RIBA - HCV RNA

Answer 37

HCV Assay results - Early HCV infection (<3 months): - Anti-HCV (EIA) - Neg. - RIBA - Neg. - HCV RNA - Positive

Question 38

HCV Assay results - Current HCV infection (acute or chronic): - Anti-HCV (EIA) - RIBA - HCV RNA

Answer 38

HCV Assay results - Current HCV infection (acute or chronic): - Anti-HCV (EIA) - Positive - RIBA - Positive - HCV RNA - Positive

Question 39

HCV Assay results - Cleared/resolved prior HCV infection: - Anti-HCV (EIA) - RIBA - HCV RNA

Answer 39

HCV Assay results - Cleared/resolved prior HCV infection: - Anti-HCV (EIA) - Positive - RIBA - Positive - HCV RNA - Negative

Question 40

HCV Assay results Interpretation: - Anti-HCV (EIA) - Positive - RIBA - Neg./Indeterminate - HCV RNA - Neg.

Answer 40

False Positive anti-HCV EIA

Question 41

What is the endpoint of treatment for HCV infection?

Answer 41

Sustained Virologic Response (SVR): | -Undetectable HCV RNA for 24 weeks after the end of treatment

Question 42

What is the most common HCV genotype in the US? | -Subclass?

Answer 42

HCV genotype 1 (70%) - Type 1a (60%) - Type 1b (10%)

Question 43

Which HCV genotype is more likely to develop resistance to treatment?

Answer 43

HCV genotype 1a

Question 44

Is Hepatitis E virus (HEV) a DNA or RNA virus

Answer 44

RNA (HEV)

Question 45

How is HEV transmitted? | Who does it typically affect?

Answer 45

- fecal-oral | - young adults (15-35 y/o)

Question 46

HEV is more virulent in what population?

Answer 46

Pregnant women -mortality rate of 30% *overall mortality is 1%

Question 47

T/F: Chronic HEV infections are rare.

Answer 47

True

Question 48

Hepatitis G virus (GBV C virus): - DNA or RNA - Virus Family - Transmission - Chronicity

Answer 48

- RNA - Flaviviridae family - Parenteral transmission - Chronic infection is common *Not clearly demonstrated to cause clinical hepatitis

Question 49

What are other viruses that cause hepatitis? (5)

Answer 49

- EBV - CMV - HSV - VZV - Yellow Fever