Hepatitis A & B Overview

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Questions and Answers

What indicates that a patient has an acute Hepatitis B infection?

Negative anti-HBe

Positive HBeAg

Positive IgM anti-HBc (correct)

Positive HBsAg

Which of the following characterizes chronic Hepatitis B infection?

Negative anti-HBc antibody

Persistent elevation of liver enzymes

Serum HBV DNA < 2000 IU/ml

HBsAg positive for more than 6 months (correct)

When should treatment be initiated for patients who are HBeAg positive?

When HBV DNA < 20,000 IU/ml

When anti-HBe is positive

When HBV DNA > 20,000 IU/ml (correct)

When ALT levels are normal

In which scenario should a patient be monitored every 3 months initially for 1 year?

Inactive HBV carrier with anti-HBe positive Signup and view all the answers

What is a characteristic of inactive HBV carrier state?

Serum HBV DNA < 2000 IU/ml Signup and view all the answers

What does anti-HBe positivity indicate in HBV infection?

Reduced replication of the virus Signup and view all the answers

Which of the following is not part of the criteria for chronic Hepatitis B infection?

Negative anti-HBe antibody Signup and view all the answers

What is the goal of monitoring treatment for Hepatitis B?

Reduce liver function test values to normal range Signup and view all the answers

Which patient populations should receive HBV immune globulin plus vaccine after exposure?

Unvaccinated individuals with sexual contact with an HBV carrier Signup and view all the answers

What is the primary mode of transmission for Hepatitis C?

Bloodborne transmission Signup and view all the answers

What is considered a virologic cure for Hepatitis C?

Sustained virologic response at 12 weeks post-treatment Signup and view all the answers

When is monitoring of the hepatic panel recommended for acute hepatitis C patients?

At 2-4 week intervals Signup and view all the answers

What should confirmatory testing follow if the initial screening for HCV is positive?

HCV RNA test Signup and view all the answers

How frequently should HCV RNA be monitored in patients with chronic hepatitis C during treatment?

Every 4-6 weeks for 6-12 months Signup and view all the answers

In which scenario is preexposure or postexposure prophylaxis for Hepatitis C recommended?

Prevention is not recommended for HCV Signup and view all the answers

Which diagnostic method provides information about the fibrosis stage in chronic hepatitis C?

Liver biopsy Signup and view all the answers

What constitutes a primary nonresponse in HBV treatment?

Decrease in HBV DNA of less than 2 log after 24 weeks Signup and view all the answers

Which reverse transcriptase inhibitor is NOT preferred as first-line therapy due to resistance?

Lamivudine Signup and view all the answers

What must be monitored when using reverse transcriptase inhibitors?

Worsening liver function tests Signup and view all the answers

Which antiviral is preferred for patients with HBV and decompensated cirrhosis?

Tenofovir Signup and view all the answers

For HBeAg positive patients, what is the minimum duration of therapy with preferred oral agents?

1 year Signup and view all the answers

What is the post-exposure prophylaxis protocol for HBV?

Administer HBV vaccine or immune globulin within 7 days Signup and view all the answers

Who is indicated for HBV vaccination?

All infants born to HBsAg negative mother Signup and view all the answers

What constitutes multidrug resistance in HBV treatment?

Combine tenofovir and entecavir Signup and view all the answers

What is the primary component used in postexposure prophylaxis for hepatitis A in unvaccinated individuals?

Immune globulin Signup and view all the answers

Which of the following groups should receive postexposure prophylaxis for hepatitis A?

Close personal contacts of an infected individual Signup and view all the answers

What is a major characteristic of acute hepatitis B virus infection?

May require serological testing for proper diagnosis Signup and view all the answers

What type of immunity does the anti-surface antigen antibody confer?

Protective immunity Signup and view all the answers

Which of the following transmission routes is NOT associated with hepatitis B?

Fecal-oral route Signup and view all the answers

In which age group is the hepatitis A vaccine specifically indicated?

12 months to 40 years old Signup and view all the answers

What is the initial test used to detect the presence of hepatitis B infection?

HBsAg testing Signup and view all the answers

Which of the following should be avoided in patients with acute hepatitis A?

Hepatotoxic medications Signup and view all the answers

What is the primary goal of therapy for HCV?

Attain a sustained virologic response (SVR) Signup and view all the answers

Which of the following is a common side effect of Ribavirin?

Hemolytic anemia Signup and view all the answers

Which drug combination is indicated for all genotypes of HCV?

Sofosbuvir / velpatasvir Signup and view all the answers

What is the required duration of treatment for HCV therapy with Mavyret in patients without cirrhosis?

8 weeks Signup and view all the answers

Which monitoring test is essential at baseline for women taking Ribavirin?

Pregnancy test Signup and view all the answers

Which of the following is NOT categorized as a protease inhibitor?

Ribavirin Signup and view all the answers

Which medication is effective for HCV genotypes 1a, 1b, 4, and 5?

Ledipasvir / sofosbuvir Signup and view all the answers

What is monitored on therapy as part of HCV treatment?

Viral load and medication adherence Signup and view all the answers

Study Notes

Hepatitis A

Transmission:
- Fecal-oral route
- Contaminated food and water
- Direct contact with an infected person
Clinical Manifestations:
- Nausea
- Fatigue
- Abdominal pain
- Jaundice
- Dark urine
- Clay-colored stools
Diagnosis:
- Serological testing for anti-HAV antibodies (IgM) and HAV antigen
Treatment:
- Supportive care
- Rest
- Hydration
- Avoid hepatotoxic medications (e.g., acetaminophen)
Prevention:
- Vaccination
- Good hygiene practices (handwashing)
Postexposure prophylaxis:
- Immune globulin for previously unvaccinated individuals within 2 weeks of exposure
- HAV vaccine for individuals aged 12 months to 40 years

Hepatitis B

Transmission:
- Parenteral (IV drug use, needlestick, transfusion)
- Body fluids (saliva, semen, vaginal fluid)
- Sexual contact
- Perinatal (mother to child at birth)
Clinical Manifestations:
- Nausea
- Fever
- Abdominal pain
- Jaundice
- Dark urine
- Clay-colored stools
- Fatigue
Diagnosis:
- Clinical signs and symptoms
- Serological tests (HBsAg, anti-HBs, anti-HBc, anti-HBe, HBV DNA)
Chronic Hepatitis B Infection:
- HBsAg positive for more than 6 months
- Serum HBV DNA > 20,000 IU/mL
- Persistent or intermittent elevation of AST and ALT
Inactive HBV Carrier State:
- HBsAg positive for more than 6 months
- HBeAg negative and anti-HBeAg positive
- Serum HBV DNA < 2000 IU/mL
- Normal AST and ALT
Treatment:
- Treatment of acute infection is not usually recommended
- Treatment for chronic infection is recommended for patients with high HBV DNA levels and abnormal liver function tests
- Medications include:
  - Tenofovir
  - Entecavir
  - Lamivudine
  - Telbivudine
Monitoring:
- Liver function tests
- HBV DNA levels
- Response to treatment
Preexposure Prophylaxis:
- Vaccination (recommended for infants born to HBsAg positive mothers, hemodialysis patients, household contacts, international travelers, injection drug users)
Postexposure Prophylaxis:
- HBV vaccine or immune globulin within 7 days of exposure

Hepatitis C

Transmission:
- Primarily bloodborne
- High risk factors include IV drug use, hemodialysis, and blood transfusions before 1992
Clinical Manifestations:
- Nausea
- Abdominal pain
- Jaundice
- Fatigue
- Dark urine
- Clay-colored stools
Diagnosis:
- Serological testing for anti-HCV antibodies
- HCV RNA testing (viral load)
- Liver biopsy (to assess fibrosis stage)
- Genotyping (six genotypes exist)
Monitoring:
- Liver function tests
- HCV RNA levels
- Response to treatment
Treatment:
- Treatment of acute and chronic infection is generally recommended
- Goal is to achieve sustained virologic response (SVR)
- Medications are used in combination, not monotherapy
- Medications include:
  - Ribavirin
  - Protease inhibitors (e.g., previr, asvir, buvir)
  - Glecaprevir/pibrentasvir (Mavyret)
  - Sofosbuvir/velpatasvir (Epclusa)
  - Ledipasvir/sofosbuvir
  - Elbasvir/grazoprevir
Duration of treatment:
- Typically 12 weeks for most medications
- 8 weeks for Mavyret if no cirrhosis
Monitoring:
- Baseline: HCV RNA, LFTs, pregnancy test for women taking ribavirin
- On therapy: Medication adherence, HCV RNA
- Post treatment: HCV RNA at 12 weeks to assess for SVR (sustained virologic response)

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Description

This quiz covers essential information about Hepatitis A and B, including their transmission routes, clinical manifestations, diagnosis, treatment, and prevention strategies. Test your knowledge on how these viruses affect individuals and the appropriate responses to exposure.