Global Perspectives

Question 1

Which hepatitis is a DNA virus?

Answer 1

Hep B

Question 2

Which hepatitis types are spread by body fluids + blood?

Answer 2

Hep B + C

Question 3

Which hepatitis types are food + water borne?

Answer 3

Hep A + E

Question 4

Which hepatitis is only found in association with hep B?

Answer 4

Hep D

Question 5

What are the signs and symptoms of acute hepatitis?

Answer 5

• Fever, malaise
• Nausea, vomiting, diarrhoea
• Jaundice, dark urine
• Right upper quad pain
• Tender enlarged Liver

Question 6

What is Hep A/E’s course and diagnosis?

Answer 6

• Incubation 2-6 weeks
• Anti HAV/HEV IgM = recent infection - persists 6 months
• Anti HAV/HEV IgG = past infection/immunisation - remains for lifetime

Question 7

How is Hep A vaccinated against?

Answer 7

Active - inactivated single dose IM injection, booster at 6 months > life long immunity
Passive - HNIG from someone with high titre anti-HAV IgG

Question 8

How is Hep (B + D) & (C) transmitted and what are the risk groups?

Answer 8

Transmission 
- Horizontal + Vertical (C) 
- Blood transfusion 
- IV drug use, needle-stick 
- Sexual 
- Hospitals
Risk Groups 
- Children of mothers with chronic HBV/HCV
- Dialysis, organ transplant 
- Prisoners
- Drug injectors 
- Multiple sex partners
- Travelors to endemic region 
- Tattoos + piercings (C)

Question 9

What is the course and diagnosis of Hep C?

Answer 9

• Asymptomatic during acute stage
• Most develop chronic
• Silent killer > end stage LD decades after infection
• Effective curative treatment available

Question 10

What is the course of acute hepatitis?

Answer 10

• Spontaneous viral clearance by immune system
• Within weeks
• Hep A, E, B (unless acquired in infancy)

Question 11

What is the course of chronic hepatitis?

Answer 11

• Viral persistance > 6months

- Hep B + C

Question 12

What is the main complication of chronic viral hepatitis?

Answer 12

• Liver fibrosis/cirrhosis
• End stage LD = portal hypertension/ascites (low albumin = low osmotic pressure), bleeding oesophageal varices, liver failure
• Hepatocellular carcinoma

Question 13

What is the structure of Hep B?

Answer 13

• HBsAg = surface antigen - used to gain entry into hepatocyte
• HBcAg = core antigen - nucleocapsid
• HBeAg = marker of high HBV replication

Question 14

What lab diagnosis is used to detect acute HBV infections?

Answer 14

HBsAg
HBeAg
Anti-HBcAg IgM

Question 15

What lab diagnosis is used to detect chronic HBV?

Answer 15

HBsAg
HBeAg
Anti-HBcAg IgG
Anti-HBeAg IgG

Question 16

What lab diagnosis is used to detect HBV clearance?

Answer 16

-ve HBsAg
-ve HBeAg
Anti-HBsAg IgG = HBV immunity
Anti-HBcAg = past HBV infection

Question 17

What lab diagnosis is used to detect HBV immunisation?

Answer 17

-ve Anti-HBcAg (as only HBsAg in vaccine)

Anti-HBsAg IgG = HBV immunity

Question 18

What is the course and diagnosis of acute Hep B & D?

Answer 18

• Incubation 6 weeks > 6 months
• Detection HBsAg = infection
• Anti-HBcAg IgM = acute
• Anti-HBsAg IgG = viral clearance post vac

Question 19

What is the course and diagnosis of chronic Hep B?

Answer 19

• Persistent HBsAg >6 months
• HBeAg = high ifectivity
• Younger exposure = more likely chronic

Question 20

How is Hep B vaccinated against?

Answer 20

Active
- HBsAg prepared in yeast
- 3 doses IM 
Passive
- HBIG

HBV immunisation also protects from HDV

Question 21

How is chronic HBV treated?

Answer 21

Antivirals - inhibit HBC reverse transcriptase + suppress viral replication

Question 22

How is Hep C diagnosed?

Answer 22

IgG antibodies

HCV RNA

Question 23

How is HCV treated?

Answer 23

Direct-acting antivirals

Blood cleared > 12 weeks = cured