Viral Hepatitis

Question 1

what do hepatitis viruses cause

Answer 1

liver disease as their chief or sole manifestation

Question 2

how is hep A spread

Answer 2

faecal oral, poor hygiene/ overcrowding

Question 3

what are the clusters of hep A

Answer 3

in gay men/ PWIDs

Question 4

can you get chronic hep A infection

Answer 4

no

Question 5

how can all hep infections be confirmed

Answer 5

yellow top bottle of blood

Question 6

how is acute hep A infection confirmed in the lab

Answer 6

clotted blood for serology (gold top vacutainer),

hep A IgM- usually detectable by onset

Question 7

where is Hep E more common

Answer 7

in tropics

Question 8

how is hep e spread

Answer 8

faecal oral

Question 9

cases of hep e in the uk are thought to be acquired from

Answer 9

zoonoses- animals/ animal meat (pigs, dear, rabbits)

Question 10

is there a vaccine for hep a

Answer 10

yes

Question 11

is there a vaccine for hep e

Answer 11

no

Question 12

who gets chronic hep e infection

Answer 12

immunocompromised

Question 13

where in hep d found

Answer 13

only in people already infected with hep b

Question 14

how is hep b spread

Answer 14

sex, mother to child, blood to blood

Question 15

who is at higher risk of hep b in the uk

Answer 15

multiple sex partners, PWIDs, children of infected mothers,

Question 16

what is vertical transmission

Answer 16

from blood at delivery

Question 17

when is an infection chronic

Answer 17

when more than 6 months (presence of HBsAg)

Question 18

what does a positive HBsAg mean

Answer 18

hep b surface antigen- present in blood of all infectious individuals

Question 19

what is usually present in highly infectious hep b patients

Answer 19

hep b e antigen HBeAg

Question 20

what s found in highly infectious hep b patients

Answer 20

HBeAg, hep B virus DNA in high titre

Question 21

where is hep B IgM most likely found

Answer 21

in recently infected patients

Question 22

when are anti-HBs present

Answer 22

in immunity to hep B

Question 23

what can provide hep B immunity

Answer 23

vaccine or past infection

Question 24

what can Hep B DNA test predict

Answer 24

risk of chronic liver disease

Question 25

when does hep B affect liver function

Answer 25

when high HBV DNA level and inflammation of liver high as immune clearance or escape occurs

Question 26

how is HEP B controlled

Answer 26

minimise exposure, vaccination (pre and post exposure), post exposure prophylaxis (vaccine + HBIG)

Question 27

how is hep c transmitted

Answer 27

same as hep B- sex, blood to blood, mother to child

Question 28

is there a vaccine for hep B

Answer 28

yes

Question 29

is there a vaccine for hep C

Answer 29

no

Question 30

can you get chronic hep C

Answer 30

yes- 75% of cases are chronic

Question 31

what are the three immediate outcomes of hep a infection

Answer 31

asymptomatic- resolution acute hepatitis- resolution acute liver failure (rare)- resolution or death

Question 32

what happens if acute hepatitis develops into chronic infection

Answer 32

can cause chronic hepatitis- resolution or cirrhosis cirrhosis- leads to cancer/chronic liver failure then death

Question 33

in hep c and hep b is there spontaneous cures to chronic infections

Answer 33

in hep B only

Question 34

how long usually does it take for cirrhosis to occur from chronic infection

Answer 34

more than 20 years

Question 35

how long does it take for cancer (hepatocellular carcinoma) to typically develop from chronic infection

Answer 35

more than 30 years

Question 36

what is another possible cure for hep infections

Answer 36

antiviral

Question 37

what are the outcomes of hep c infections

Answer 37

acute infection or asymptomatic asymptomatic- (25% resolution) chronic infection- chronic hepatitis, cirrhosis 9or cancer), chronic liver failure, death

Question 38

what is usually the presenting complaint asymptomatic hep c infection

Answer 38

signs of chronic liver disease after decades of no symptoms

Question 39

how many people develop chronic infection in hep B

Answer 39

less than 5%, most resolve naturally

Question 40

what is infection of children with hep B like

Answer 40

more like pattern of hep C infection: high levels of chronic infection and complications

Question 41

what is the most common hep infection locally

Answer 41

hep E

Question 42

what can a positive antibody test for hep c not distinguish between

Answer 42

past or active infection

Question 43

how do you distinguish between a past or active hep c infection

Answer 43

hep c virus RNS by PCR- pos= active infection

Question 44

what is the antibody for hep c

Answer 44

IgG

Question 45

what is hep c virus control

Answer 45

no vaccine- minimise exposure

Question 46

what is the management for acute viral hepatitis

Answer 46

no antivirals monitor for encephalopathy (brain disease, damage or malfunction) monitor for resolution notify public health immunisation of contacts test for other infections vaccinate against other infections if at risk

Question 47

how is chronic viral hepatitis managed

Answer 47

anti virals (adefovir, entercavir, tenofovir, interferon alpha, peginterferon etc) vaccination (against other hep viruses and if cirrhotic influenza and pneumococcal) infection control reduced alcohol hepatocellular carcinoma awareness/ screening

Question 48

who should get antivirals

Answer 48

patients with; chronic infection risk of complications (evidence of inflammation/ fibrosis) who are fit for treatment (cirrhotic treated as priority although established cirrhosis harder to treat, liver cancer contraindication, HIV coinfection contraindication)

Question 49

when should anti virals be given

Answer 49

before complications, when evidence of inflammation, when patient ready/ clinical priority

Question 50

what is interferon alpha

Answer 50

human protein that is part of the immune response to viral infection

Question 51

what are the side effects of interferon | alpha when given as antiviral via injection

Answer 51

minor; flu like symptoms major: autoimmune disease, psychosis

Question 52

what is peginterferon used to treat

Answer 52

hep c

Question 53

what are the adverse effects of peginterferon

Answer 53

common: flu like symptoms- chills, sore muscles- malaise rare, more severe: thyroid disease, autoimmune disease (SLE), psychiatric disease

Question 54

what are the adverse effects of ribavirin

Answer 54

anaemia

Question 55

what are the two treatment options for chronic hep b

Answer 55

suppressive antiviral drug (entecavir, tenofovir)- safer but suppression not cure peginterferon- cure but side effects

Question 56

how does viral suppression work

Answer 56

reduction in HBV DNA and loss of HBeAg

Question 57

how do anti viral cures work

Answer 57

loss of HBsAg

Question 58

what are the aims/ benefits of chronic hep C therapy

Answer 58

virological, improved liver biochem and histopathology, reduced infectivity progression to cirrhosis and cancer and mortality

Question 59

what is sustained virological response (SVR)

Answer 59

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

Question 60

what antiviral works against all virus genotypes

Answer 60

sofosbuvir, voxilaprevir, velpatasvir

Question 61

what is the standard treatment for HCV

Answer 61

interferon free courses of 2 or 3 antivirals- choice based on genotype of virus and load, stage of disease