Viral Hepatitis

Question 1

How is hepatitis A spread?

Answer 1

Faecal-oral
Poor hygiene/overcrowding

Some cases are imported

Question 2

Who usually gets hep A?

Answer 2

Gay men

People who inject drugs

Question 3

What might be the clinical presentation of hep a?

Answer 3

Acute hep, no chronic infection

Peak incidence of symptomatic disease in older children/younger adults

Question 4

What might you find on investigation when diagnosing hep?

Answer 4

Hep A IgM

Question 5

How would you treat/control hep a?

Answer 5

Supportive treatment
Hygiene
Vaccine prophylaxis - takes about 10 days to take effect

Infected food handlers excluded from the workplace

Question 6

Where is hep e more common?

Answer 6

In the tropics

Question 7

What is the transmission of hep e?

Answer 7

Faecal oral transmission

Zoonoses (infected animals can pass it onto humans)

Causes acquired in the topics are thought to be human to human spread

Question 8

Can hep E become chronic?

Answer 8

Not usually but some immunocompromised humans can get chronic infection

No vaccine yet

Question 9

When do you find hep D?

Answer 9

Only found with Hep B

Question 10

What does hep D do to help B?

Answer 10

Exacerbates hep b virus infection

Co-infection or superinfection

Question 11

How is hep B viruses transmitted?

Answer 11

Blood-Blood
Sexual transmission
Vertical transmission - mother to child

Question 12

When are you more likely to get chronic infection of hep B?

Answer 12

If you had your first exposure in childhood

Question 13

Who are at a higher risk of getting hep B in the UK?

Answer 13

People who are born in areas of intermediate/high prevalence
Multiple sexual partners
People who inject drugs
Children of infected mothers

Question 14

Describe HBsAg?

Answer 14

Present in the blood of all infectious individuals

Present for more than 6 months in chronic infection

Question 15

Describe HBeAg?

Answer 15

Occurs shortly after HBsAg usually indicates highly infectious individual

Question 16

Describe Hep B virus DNA

Answer 16

Gives indication of infectivity - the more you have the more infectious you are

Also used to predict risk of chronic liver disease and to monitor therapy

Question 17

Describe Hep B IgM?

Answer 17

Most likely to be present in recently infected - acute

Question 18

Describe Anti-HBs?

Answer 18

Present in immunity

Question 19

Are HBV DNA more or less sensitive predictors or prognosis and infectivity than HBeAg?

Answer 19

More sensitive

Question 20

What might immunity be due to?

Answer 20

vaccine or due to past infection

Question 21

How would you control and treat Hep B?

Answer 21

minimise exposure - safe blood, sex, needle exhancge, screening of pennant women

Pre-exposure vaccination - vaccination of at risk people, vaccination of all children/adolescents

Post exposure prophylaxis - vaccine, plus HBIG (hyperimmune Hep B immunoglobulin)

Question 22

What is the transmission of hep c?

Answer 22

Similar to hep B

blood/sexual

Question 23

What is the treatment for hep c?

Answer 23

No vaccine available

Question 24

What does infection of hep c usually result in?

Answer 24

Chronic infection

Question 25

If a patient comes back with positive for hep c virus antibody, how do you know if they have an active infection or a past infection?

Answer 25

Test for hep c virus RNA by PCR Negative - past Positive - active

Question 26

How many months of an infection defines chronic?

Answer 26

More than 6 months

Question 27

How long does is usually take from the time of infection to develop cirrhosis?

Answer 27

Typically >20 years

Question 28

How long does it usually take from the time of infection to develop hepatocellular carcinoma?

Answer 28

Typically >30 years

Question 29

What is the management of acute viral hepatitis?

Answer 29

``` Symptomatic No antivirals given Monitor for encephalopathy Monitor for resolution (of hep b,c, or e if immunocompromised) Notify public health Immunisation of contacts Test for other infections if at risk Vaccinate against other infections if at risk ```

Question 30

What is the management of chronic viral hepatitis?

Answer 30

Antivirals Vaccination - other hepatitis viruses, if cirrhotic - influenza, pneumococcal Infection control Alcohol decrease Hepatocellular carcinoma awareness/screening

Question 31

What are the common antivirals used in chronic infection?

Answer 31

Adefovir | Entecavir

Question 32

Who do you treat with antivirals?

Answer 32

Those with HCV RNA present and genotype known HBsAg and Hep B DNA present Risk of complications Fit for treatment - liver cancer = contraindication

Question 33

What is interferon alfa?

Answer 33

A human protein - part of the immune response to viral infection

Question 34

What are some adverse effects of peginterferon?

Answer 34

Flu like symptoms - chills, sore muscles, malaise Less common but more severe - thyroid disease, autoimmune disease

Question 35

What is an adverse effect of Ribavirin?

Answer 35

Anaemia

Question 36

Describe 2 diffrent options to treat chronic hep b?

Answer 36

1 - Peginterferon alone. (HBsAg and HBeAg positive - compensated disease and prediction of good chance of cure) 2 - Suppressive antiviral drug (entecavir, tenofovir) - safer, suppression not a cure

Question 37

When do you know if you have cured hep B?

Answer 37

When there is loss of HbsAg

Question 38

What is response defined by in hep C?

Answer 38

By loss of HCV RNA in the blood sustained to 6 months after end of therapy

Question 39

What is the aim in Hep C therapy?

Answer 39

Move towards interferon free combination drugs