viral hepatitis

Question 1

known hep viruses

Answer 1

A,B,C,D,E, G
only A-E known to cause clinical disease
only B, C, D cause chronic infections (>6 months)

Question 2

which hep diseases cause chronic infection

Answer 2

B, C, D

Question 3

which hep disease cause clinical disease

Answer 3

A-E

Question 4

hepatitis E causes

Answer 4

can cause chronic infections in transplant recipients, or immunosuppressed

Question 5

other viruses causes hepatitis disease

Answer 5

EBV, CMV, yellow fever virus

Question 6

more common hep viruses in Australia

Answer 6

B and C

Question 7

you can only have hep d if

Answer 7

you have chronic hep B

Question 8

hepatitis A is found

Answer 8

found world wide

hyper endemic in developing countries

Question 9

hap A spread by

Answer 9

faecal orla route

excretion for 1-2 weeks before illness to 1 week after ilness

Question 10

risk groups for hep A

Answer 10

child day-care centres and pre schools
MSM
IVDU
residential facilities for the intellectually disabled
travellers to Asia, Africa, South Pacific, central and South America

Question 11

serotypes of hep A

Answer 11

only one serotype
infection gives life long immunity
vaccine very effective and long lasting protection with 2 doses

Question 12

diagnosis of hep A

Answer 12

detection of IgM for acute disease (lasts 6-9 months)
IgG for immunity after natural infection
PCR of blood and stool

Question 13

hep E spread

Answer 13

• under developed countries, spread by contaminated water

- developed countries, spread fro contaminated food (pork)

Question 14

hep E illness

Answer 14

5% develop jaundice, especially older men in developed countries
extra hepatic manifestations (neurological)
mortality up to 20%

Question 15

hep E vaccine

Answer 15

none

Question 16

hep E diagnosis

Answer 16

serology or PCR

Question 17

hep E chronic disease

Answer 17

occurs in immunosuppressed or organ tranplant recipients

Question 18

Hep B found in

Answer 18

highest in underdeveloped people
maintained through vertical transmission
especially in Asia
majority now have universal childhood vaccination campaigns

Question 19

hep B in western countries

Answer 19

• sexual transmission

- Australian cases usually from countries where it is endemic

Question 20

hep B clinical presentation

Answer 20

15-25% will die from cirrhosis for hepatocellular cancer if not given appropriate treatment
children show no symptoms and will be lifelong carriers

Question 21

outcomes of hep B transmission

Answer 21

• no or moderate fibrosis with minimal risk of complications - can still develop hepatocellular carcinoma
• develop cirrhosis - more common if high HBV viral load, HBeAg +ve, raised ALT, older, other liver toxins eg. alcohol
• develop hepatocellular carcinoma, more common is cirrhotic, family history, ethnicity, male

Question 22

immune tolerance stage

Answer 22

high levels of viral load but immune system not reposting
HBeAg positive which is a reflection of high viral load
liver function tests normal

Question 23

immune clearance stage

Answer 23

abnormal LFTs
viral load reduces
at risk of progression to cirrhosis and hepatocellular carcinoma - should be referred for treatment

Question 24

immune control stage

Answer 24

normal LFTs
low viral load
HBeAg neg, HBeAb pos
may maintain this stage for the rest of life
low risk for chronic liver disease due to low viral load

Question 25

immune escape stage

Answer 25

virus changes such that it can escape immune control high viral load, abnormal LFTs at risk of progression to cirrhosis and hepatocellular carcinoma e antibody positive but still high viral load

Question 26

antivirals for hep B

Answer 26

DNA virus goes to the nucleus and reproduces itself and produces an RNA copy can do reverse transcriptase takes RNA and turns it back to DNA to be packaged and excreted antivirals act on reverse transcriptase - can't produce genome so the virus can't replicate

Question 27

antivirals examples

Answer 27

entecavir and tenofavir

Question 28

indications for antivirals in Hep B

Answer 28

- immune clearance and immune escape phases - immune active - cirrhotics - pregnancy - immunosuppression

Question 29

HBV and pregnancy

Answer 29

HBeAg positive mothers - transmission 90% without prophylaxis HBIG + vaccine at birth reduces risk of vertical transmission 90% tenofovir in third trimester to reduce viral load

Question 30

cirrhosis

Answer 30

HCC in HBV can occur without cirrhosis but Is more likely in cirrhosis

Question 31

cirrhosis screening

Answer 31

ultrasound of the liver every 6 months for all hep B cases that are cirrhotic to intervene early If there is cancer

Question 32

staging

Answer 32

cirrhosis and fibrosis staging | checking renal function and coagulopathy

Question 33

HBV vaccine

Answer 33

universal for infants since 2000 subunit vaccine immunity indicated if level HBsAb level >10

Question 34

hep D

Answer 34

deltavirus, defectieve satellite RNA virus | uses HBsAg coat (doesn't have its own coat - borrows from hep B which is why Hep B coinfected needed)

Question 35

hep D causes

Answer 35

acute or persistent infection in HBsAg infected

Question 36

hep D diagnosis

Answer 36

screen with anti-HDV serology and confirm active infection with HDV viral load

Question 37

hep D vaccine

Answer 37

no vaccine | interferon therapy for 1-2 year with low response rate

Question 38

hepatitis C

Answer 38

``` lipid coated RNA virus no reverse transcriptase unstable genome - immune escape for chronic infection - antiviral resistance mutations ```

Question 39

hep C found

Answer 39

around the world foci in underdeveloped countries steady increase in australia with intravenous drug users

Question 40

transmission risks of hep C

Answer 40

parenteral (blood exposure) - developed countries - IVDU, tattoos, transfusion - developing countries - medical practises and traditional practises vertical sexual - low risk but increased with genital ulceration, higher risk with anal intercourse

Question 41

sexual transmission of hep C

Answer 41

low risk but increases with genital ulceration of anal intercourse

Question 42

serology for hep C

Answer 42

HCV total antibody HCV antigen - not used in aus no rapid point of care tests

Question 43

molecular diagnosis of hep C

Answer 43

qualitative PCR viral load, genotyping directly acting antiviral resistance mutation testing for those who have failed direct acting antivirals

Question 44

DAA

Answer 44

direct acting antivirals current ones used in australia are pan-genotypic epclusa, maviret, vosevi (escape treatment)

Question 45

HCV treatment

Answer 45

``` treatments have drug interactions some can't be used in renal impairment can cause reactivation in HBV/HCV confection can't be used in pregnancy treatment success in 90-95% ```