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Nagasaki Flashcard Extravaganza > Hepatitis > Flashcards

Hepatitis Flashcards

1
Q

What is the incubation period for Hep A?

A

15-45 days

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2
Q

What kind of virus is Hep A?

A

RNA - picornavirus

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3
Q

What is the transmission route for Hep A?

A

Faeco-oral (food, water, MSM sex)

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4
Q

What is the treatment for hep a?

A

Supportive
Admit if severe symptoms, coagulopathy, dehydrated, coinfected

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5
Q

What is PN for Hep A?

A

2 weeks before and 1 week after jaundice

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6
Q

What percentage of Hep A cases develop ALF?

A

0.4%

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7
Q

How long can vaccination or IVIG be given to contacts in hep b?

A

14 days (really vax up to 6/52 and should give ivig within 1 week)

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8
Q

Who is eligible for Hep A vaccination?

A

MSM
PWID
Hep co-infection

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9
Q

What kind of virus is Hep B?

A

Hepnavirus - DNA

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10
Q

What is the incubation period for hep
B?

A

40-160 days

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11
Q

How many HBV genotypes?

A

8

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12
Q

How is Hep B transmitted?

A

Sexual
Vertical
Household
Parental

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13
Q

How often does Hep B progress to ALF?

A

1%

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14
Q

When is Hep B considered chronic?

A

Surface antigen > 6 months

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15
Q

What is the prevelance of Hep B?

A

0.01- 0.04% in blood donors and to >1% in PWID and MSM

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16
Q

What factors increase risk of chronic Hep B?

A

Other Hep co-infection
Immunosuppression inc HIV
Vertical transmission

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17
Q

Who is at risk of Hep B?

A

MSM
CSW
PWID
People from, or have partner from, or born to people from endemic areas
Needlestick
SA victims

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18
Q

Who should be vaccinated against hep b?

A

MSM
IVDUs & sexual partners of IVDUs
CSW+Men who have sex with CSW
PEPSE
Current partner has Hepatitis B or known HBV positive sexual contact within the last 6 weeks
Sexual Assault
Those in whom infection would cause severe disease: (HIV+ve; Hep C +ve)
Babies born to mothers infected with hepatitis B.
Needlestick injury.

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19
Q

Who should have IvIG after exposure to hep b?

A

High risk groups (pregnant, older, immunosupressed, hep co-infected)
Babies to mother’s with high risk chronic
Known hep b non-responders who needlestick

Best within 48h, can be given up to a week

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20
Q

What is the timeframe for IVIG in Hep B

A

48 hours best, no more than 7 days

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21
Q

Indications for liver biopsy in Hep B?

A

Cause of hepatitis remains unknown
Staging of chronic disease
Cirrhosis diagnosis
Malignancy investigation

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22
Q

What are the delivery implications for mothers with Hep B?

A

Avoid invasive monitoring and instrumentation

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23
Q

Can you breastfeed with hep b?

A

Yes

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24
Q

How should a baby be managed born to a mother with Hep B?

A

Infants of HBsAg +ve but HBeAg -ve mothers: vaccine only
Infants of HBsAg +ve + HBeAg +ve: vaccine +HBIG

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25
Q

Hep B vax in HIV patients

A

Full course 0,1,2,6
If <10 - full course
If 10-100 boost one dose

26
Q

Lifetime risk of HCC in Hep B

A

15% to 40%

27
Q

What is the incubation period for Hepatitis C?

A

Two weeks to six months

28
Q

How are contacts of Hep C managed?

A

Screening
No vax available

29
Q

What is the transmission route for Hep C?

A

Blood bourne - needles, MSM sex, rarely vertical

30
Q

What % patient clear Hep C spontaenously?

A

25%
10% if living with HIV

31
Q

What proportion of Hep C patients are asymptomatic?

A

70%

32
Q

What dose of Hep B vax is given in HIV?

A

40mg rather than 20mg regardless of CD4

33
Q

Rate of ALF in Hep C?

A

1%
More likely if has Hep A

34
Q

When is Hep C chronic?

A

> 6 months

35
Q

When should Hep C be treated?

A

Patients with acute HCV should be followed with four-weekly HCV RNA quantitation; if there is less than a 2 log10 decline in HCV RNA at week 4 or the HCV RNA remains positive at week 12, they should be
considered for treatment in the acute phase.

36
Q

When should Hep C be treated in pregnancy?

A

Basically never - should be avoided

37
Q

What should patients be advised to do in Hep C?

A
  • In acute infection, patients should be advised to avoid unprotected sexual
    intercourse
    *In patients with chronic infection, sexual transmission should be discussed. It
    seems likely that if condoms are used consistently then sexual transmission will
    be avoided, but given the very low rates of transmission outside of HIV co-
    infection monogamous partners may choose not to
    Sexual contacts with HIV should be advised of the risk of sexual transmission, with condom use encouraged
    Advice for MSM and HIV+ MSM should include use of condoms, gloves for
    fisting, single person only sex toys/condoms on sex toys and changed between partners. Also not to share lube and avoid group sex situations
    Cannot donate blood, semen, organs
38
Q

What is Hepatitis D?

A

Virus which only occurs in Hep B “delta” - more severe

39
Q

Who is at risk from Hep E?

A

Pregnant women and children
Genotypes 1/2 (non Europe)

40
Q

Rate of delta infection?

A

5% globally

41
Q

What kind of virus is Hep D

A

Incomplete RNA virus

42
Q

Management of chronic Hep B

A

Screen for Hep C, Hep D and Hep A immunity
Vaccinate for Hep A if non-immune
Refer chronic HBsAg+ve patients to a specialist

Decision to treat depends on pattern of disease, HBV DNA level + presence / absence of necro-inflammation and hepatic fibrosis.

Tenofovir-DF or tenofovir-AF
or entecavir
or pegylated interferon

43
Q

Impact of HIV confection on HCV infection

A

higher HCV viral loads,
faster rates of fibrosis progression
increased risk of cirrhosis
more frequent development of end-stage liver disease / hepatocellular carcinoma / liver-related death
The efficacy of pegylated interferon (PEG-IFN) lessens as the CD4 cell count declines

44
Q

Of the 80% of patients who do not spontaneously clear HCV infection, what % never develop liver damage or symptoms

A

20%

45
Q

What % of patients with HCV will develop liver hepatocellular carcinoma?

A

1-2%

46
Q

How does HIV infection affect response to treatment for Hep C

A

HIV positive patients respond to treatment with DAAs as well as HIV- negative patients

bear in mind drug-drug interactions between DAAs and antiretroviral therapy

47
Q

How long does HCV serology take to become +ve after exposure

A

3 months after exposure in 90% - for antibody test
can take as long as 9 months

2 weeks for HCV- RNA

48
Q

What proportion of patients with HCV are asymptomatic

A

60%

49
Q

Complications of chronic Hepatitis C

A

cirrhosis (5-20% after 20 years)
hepato-cellular carcinoma (after 30 years)
acute liver failure - requiring liver transplantation 1%
death

treatment-related hepatitis B reactivation
rheumatological complications
skin lesions include porphyria, cutanea tarda and lichen planus
cryoglobulinaemia
glomerulonephritis
keratoconjunctivitis sicca (dry eyes)
Mooren ulcer (a rapidly progressive, painful ulceration of the cornea)

50
Q

Diagnosis of chronic Hep C infection

A

HCV RNA assay is positive 6 months after the first positive test

51
Q

How is HCV cure defined

A

negative HCV RNA in blood 12 weeks after completion of HCV treatment

52
Q

How do direct acting antivirals work?

A

DAAs target HCV non-structural proteins to prevent viral replication

53
Q

How long does the protection provided by monovalent Hep B vaccination last?

A

> 20 years once immunity confirmed

54
Q

After primary HBV infection what % of infants infected perinatally have persistent HBV?

A

HBV persists in 90% of infants infected perinatally

55
Q

Factors that reduce responses to HBV vaccination

A

A
age >40 years
obesity
male gender
haemodialysis
smoking
immunocompromise - including HIV infection

56
Q

Can you breastfeed with Hep C?

A

Yes

57
Q

Extrahepatic manifestations of Hep B?

A

PAN
GN
Myocarditis
Rash
Arthritis

58
Q

Vertical transmission rate of HCV

A

5%
Up to 10% if HIV co-infected

59
Q

How are Hep A contacts managed?

A

HNIG + vax for> 60 and over within 14 days of exposure or HIV
infected and with a CD4 count <200 cells/ mm3, or otherwise immune supressed
Vax for non immune close contacts esp if >60 or food handler
Vax is usually 2 weeks but may be up to a month

60
Q

What is the advice for food handlers exposed to Hep A?

A

For close contacts who are food handlers and have not been immunised within 14
days of exposure and are at high risk of acquiring infection, reinforcement of
hygiene is recommended and where possible the close contact should be advised
to restrict activities to those which do not involve preparing and handling unwrapped ready-to-eat-food until 30 days post exposure unless demonstrated to be immune; exclusion from work is only considered if scrupulous hygiene cannot be achieved

61
Q

Hep A treatment

A

Avoid alcohol
Avoid food prep
Avoid preg women
Vaccinate contacts
Supportive

62
Q

Hep B treatment

A

Tenofovir, lamivudine, adefovir (rare)
6/12 USS for HCC screening and AFP

Nagasaki Flashcard Extravaganza (33 decks)

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