Viral Hepatitis Flashcards
(53 cards)
1
Q
Where is HAV worst?
A
S America
Africa
Asia
Greenland
2
Q
What type of Hepatitis is HAV?
A
Acute hepatitis IP 2-6 weeks
Often subclinical
Faecal-oral spread
Notifiable
3
Q
How do the immunoglobulins change in HAV?
A
IgM rises first
IgG rises after
ALT spikes with IgM
HAV in stool just before and during infection
4
Q
What is the molecular organisation of HBV?
A
- The family Hepadnaviridae
- Double-strained DNA with reverse transcriptase
- Enveloped virions
5
Q
Where are the clades endemic for HBV?
A
10 genotypes (A-J) with distinctive geographic distribution
6
Q
How is HBV spread?
A
- Sexual
- Vertical
- Blood products
7
Q
What kind of infection is HBV?
A
- ACUTE and CHRONIC
- Chronic = 6 months or more
8
Q
How does HBV antigens change over time?
A
9
Q
What are the disease stages of HBV?
A
- Immune tolerant
- Immune reactive
- Inactive HBV carrier state
- HBeAg negative chronic HBV
- HBsAg negative phase
10
Q
When might HBV cause cirrhosis?
A
When baseline HBV DNA is >10^6
11
Q
What is the treatment of chronic HBV?
A
- Interferon alpha
- Lamivudine
- Adefovir
- Tenofovir
- Entecavir
- Emtricitabine
12
Q
Where is HCV highest?
A
Parts of SA, Africa, Asia
13
Q
What is Hep C?
A
- Flaviviridae
- Mainly blood product spread
- 60-80% chronicity
- Natural history
14
Q
What enzymes does HCV use?
A
NS3/4 serine protease, RNA helicase
NS5A
NS5B RNA dependent RNA polymerase
15
Q
What type of infection is HCV?
A
Acute 20-40%
Chronic 60-80%
16
Q
Antibodies/ ALT in HCV?
A
ALT spikes and then anti HCV
17
Q
How do you treat acute HCV?
A
Peginterferon alfa
Protease inhibitors:
telaprevir
boceprevir
simeprevir
asunaprevir
paritaprevir (ABT-450/r)
grazoprevir (MK5172)
vaniprevir
faldaprevir
deleoprevir
ledipasvir
daclatasvir
ombitasvir (ABT- 267)
elbasvir (MK-8742)
sofosbuvir
dasabuvir (ABT-333)
beclabuvir (BMS- 791325)
ABT-072
deleobuvir
18
Q
Where to the DAAV act?
A
19
Q
Where is HDV high?
A
Some parts of SA and Africa
20
Q
What is the serological course for HDV superinfection?
A
21
Q
A
22
Q
What is the serological course for HDV superinfection?
A
23
Q
Where is HEV worst?
A
Africa and Asia
24
Q
What is the most common acute hepatitis?
A
HEV
25
What are the genotypes of HEV?
Genotype 1 and 2 – human, epidemic
Genotype 3 and 4 – swine and other
(humans accidental host = zoonosis)
Very little person to person spread
Case reports
Shellfish consumption, blood transfusion
Sausages, pig liver consumption
26
How do you treat HEV?
supportive ? ribavirin
27
What are the complications of HEV?
Incubation period 3-8 weeks
High mortality rate in pregnancy ( genotype 1)
RARE COMPLICATIONS
CNS disease – Bell’s palsy, Guillain Barre, other neuropathy
Chronic infection
28
Is there a Vx for HEV?
VACCINE – EFFECTIVE - trials with recombinant HEVg1
In Nepalese military and Chinese (100 000)
29
What is the serology of HEV?
30
31
What is the epidemiology of Hepatitis A?
* Approx. 1.5 millions of cases worldwide annually
* Developing countries with poor socio-economic conditions
* 300-500 cases annually in the UK
* Mostly among age 15-34 and non-travellers
* Outbreaks among MSM (2016/17) & IVDU (2001 & 2017)
32
What are the clinical manifestations of hepatitis A?
* Wide disease spectrum from asymptomatic to fulminant hepatitis
* Strong correlation with age: \<10% symptomatic among children \<6 years old versus 70% in adults
* Typical symptoms: fever, malaise, anorexia/nausea, abdominal discomfort, diarrhoea, jaundice
* Extra-hepatic diseases
* Acute presentation; 99% resolution
* NOT an aetiology for chronic hepatitis
33
What is the diagnosis and treatment of HAV?
•Diagnostics based on HAV serology
ØAcute infection: IgM reactive; unlikely if bilirubin level \< 30umol/L
ØPast infection: IgM non-reactive, IgG reactive
•Supportive treatment
34
How do we alert public health for HAV?
•Notifiable disease in the UK – must alert HPT immediately upon diagnosis
•
* Infectious period of index case: two weeks before onset of first symptoms and until one week after the onset of jaundice
* Pre-exposure immunisation among population at risk
* Post-exposure prophylaxis
ØWithin 14 days of exposure to index case: HAV vaccine +/- HNIG (for 60 years and above, chronic liver diseases inc CHB/CHC, immunocompromised contact)
ØOver 14 days: HAV vaccine +/- HNIG (for chronic liver diseases inc CHB/CHC, immunocompromised contact)
35
What are the clinical manifestations of acute hepatitis?
•Age related presentation & prognosis in acute hepatitis B
ØNeonates & children: mostly asymptomatic or anicteric; 90% HBV-infected neonates develop CHB, and 30% among children age \<5 years
ØAdult: 30-50% icteric hepatitis; 10% become CHB
* 0.1-0.05% risk of fulminant hepatitis; related to co-infection with HCV/HDV
* Maternal HBeAg/Ab status & HBV viral load
ØHBeAg as the most important risk predictor for vertical transmission
36
What are the clinical manifestations of chronic hepatitis B?
* Definition: persistence of HBsAg for 6 months or more after acute HBV infection
* Complications
ØCirrhosis: 8-20% untreated CHB in 5 years;
ØHepatocellular carcinoma: the annual risk of 2-5% among CHB cirrhotic patients; affected by host (e.g. alcohol abuse) and viral factors (e.g. high HBV viral load & qHBsAg)
37
38
What is the epidemiology of hepatitis B?
Approximately 296 million people are living with CHB worldwide; CHB-related mortality at roughly 820,000 people per year
39
How do you interpret HBV serology?
* HBsAg: infection
* HBsAb: immunity through either immunisation or past infection
* HBcAb: exposure
ØIgM: acute infection
* HbeAg: replication activity
* HBeAB
40
41
What is the prevention/public health for HBV?
* Acute hepatitis B: a notifiable disease
* Pre-exposure prophylaxis
ØRoutine childhood immunisation in the UK since 2017
ØHigh risk population
•Post-exposure prophylaxis
ØNeonate born to mother living with hepatitis B
ØSexual partner: HBV vaccine +/- HBIG (within one week from the contact)
ØNeedle stick injury
42
What is HDV?
* Single-stranded, circular RNA genome
* A defective virus that relies on HBV for propagation
* Blood-borne transmission
* Incubation period: 3-6 weeks
43
What is the HBV/ HDV co-infection?
•HBV/HDV simultaneous co-infection
ØSimilar to classic acute hepatitis B; mostly self-limited
Ø\<5% chronic infection
•HDV super-infection in CHB
Ø80% chronic infection
ØIncreased risk of cirrhosis and HCC than CHB alone
44
What is the diagnosis/ treatment/ prevention of HDV?
* Anti-HDV serology; other HDV investigations rarely used
* PEG-interferon alpha licensed for HDV superinfection in CHB
* Pre-exposure HBV immunisation
* Acute HDV infection: notifiable disease
45
What is Hep C?
* The family Flaviviridae, genus Hepacivirus
* Single-stranded, positive sense RNA genome
* Blood borne transmission
* Incubation period: 2-6 weeks
* 58 million people living with chronic hepatitis C worldwide
* 1.5 million new cases every year
46
What is the clinical manifestations of Hep C?
•Acute infection
Ø30% spontaneous clearance
Ø70% become chronic hepatitis C (CHC)
* Hepatic versus extra-hepatic manifestation
* Cirrhosis (15-30% in 20 years) & HCC as complication of CHC
47
What is the antibodies for HCV?
48
What is the treatment of HCV?
* Revolutionised the treatment for acute/chronic HCV infection
* Any HCV cases should be considered
* 8 or 12 weeks
* Sustained virological response (SVR) at week 12
* Pan-genotypic regimen
* Single-tablet regimen
* Drug-drug interaction
49
What is the prevention/ public health of Hep C?
* Acute hepatitis C: notifiable disease in the UK
* Nil vaccine available
* Nil post-prophylaxis available
* Active HCV screening
* Risk reduction (e.g. safe handling and disposal of sharps, protected sex)
50
What is HEV?
•The family Hepeviridae, genus Orthohepevirus; species A strains (8 genotypoes) infect humans
ØG1 & G2: obligate human pathogens
ØG3 & G4: zoonotic; pigs & wild boar are natural hosts
* Single-stranded, positive sense RNA genome
* Quasi-enveloped HEV
* Faeco-oral versus blood-borne transmission
* Incubation period: 15-60 days
* Approximately 20 million new HEV cases worldwide annually
* 3.3m symptomatic hepatitis E
* 44,000 mortality annually
* UK is a HEV G3 endemic country
51
What are the clinical manifestations of Hep E?
* Mostly self-limited; advised against alcohol during the course
* At risk population
ØPregnant women: G1; fulminant hepatic failure and obstetric complications (e.g. eclampsia and haemorrhage); 25% maternal mortality & high perinatal infant mortality
ØChronic liver disease patients
ØImmunocompromised patients: may develop chronic hepatitis E (G3 & G4)
•Hepatic versus extra-hepatic manifestations
52
How do you diagnose HEV?
* Immunocompetent: HEV serology
* Immunocompromised: HEV PCR
53
What is the treatment and prevention of HEV?
* Only indicated in chronic hepatitis E as most acute HEV infection are self-limited
* Acute HEV infection: a notifiable disease
* HEV patient should avoid prepping food during the first 2 weeks
* Immunocompromised and chronic liver disease patients should avoid consumption of undercooked meat (pork, wild boar and venison) and shellfish
ØHEV vaccination: only licensed in China
