Viral hepatitis

Question 1

What are the 5 types of heatitis viruses?

Answer 1

A, B, C, D and E

Question 2

How is hepatitis A spread?

Answer 2

Faecal-oral spread
Due to poor hygiene or overcrowding
Clusters in gay men and PWID

Question 3

What is the clinical presentation of hepatitis A?

Answer 3

Acute hepatitis, no chronic infection

Peak incidence of symptomatic disease in older children/ young adults

Question 4

How is hepatitis A diagnosed?

Answer 4

Lab confirmation of acute infection via the presence of hepatitis A IgM

Question 5

How is hepatitis A controlled?

Answer 5

Good hygiene

Vaccine prophylaxis

Question 6

Where is hepatitis E common?

Answer 6

In the tropics `

Question 7

How is hepatitis E transmitted?

Answer 7

Faecal-oral transmission
Evidence of chronic infection in pigs
Cases in UK are though to be zoonosis

Question 8

Who can get hepatitis D?

Answer 8

Only found with Hep B, it is a parasite of a parasite and exacerbated hep B infection. It is a co-infection or superinfection

Question 9

How is Hep B transmitted?

Answer 9

Sex
Mother to child
Blood

Question 10

When are chronic infections likely to occur in hep B?

Answer 10

If first exposure is in childhood

Question 11

Who is at high risk in the UK for infection of Hep B virus?

Answer 11

People born in areas of high prevalance
Multiple sexual partners
PWID
Children of infected mothers

Question 12

What does hepatitis B surface antigen (HBsAg) show?

Answer 12

Indicates a patient is infected and infectious. More than 6 months indicates a chronic infection

Question 13

What does Hepatitis B e antigen (HBeAg) show?

Answer 13

Usually high in highly infectious individuals

Question 14

What does Hep B virus DNA show?

Answer 14

Predicts prognosis and infectivity

Question 15

What does hep B IgM show?

Answer 15

Recently infected - acute cases

Question 16

What is present in people who are immune to hep b?

Answer 16

Anti-HBs

Question 17

How is hepatitis B controlled?

Answer 17

Minimise exposure: safe blood, safe sex, needle exchange, prevention of needlesticks, screening of pregnant women
2 pre-exposure vaccination strategies
Post-exposure prohpylaxis - vaccine plus hyperimmune Hep B immunoglobulin

Question 18

How is Hep C transmitted?

Answer 18

Similar to Hep B but no vaccine avaliable

Question 19

What defines a chronic infection?

Answer 19

6 months of infection

Question 20

How is hepatitis C diagnosed?

Answer 20

Test for antibody to hepatitic C virus, is it positive this indicates a pat or active infection and then need to test for Hep C viruse RNA via PCR

Question 21

What does it mean if the hep C RNA is found via PCR?

Answer 21

Active infection

Question 22

How is hepatitis C controlled?

Answer 22

No vaccine, minimise exposure

Question 23

How is acute viral hepatitis managed?

Answer 23

No antiviral, monitor for encephalopathy and monitor for resolution
Notify public health
Immunisation of contacts if poss
Test for other infections

Question 24

What are notifiable diseases?

Answer 24

Those that are vaccine preventable, and others that can cause outbreaks or public alarm or high mortality

Question 25

What are the common antivirals used in HBV therapy?

Answer 25

Adefovir | Entecavir

Question 26

How is chronic viral hepatitis managed?

Answer 26

``` Antivirals Vaccination Infection control No alcohol Hepatocellular carcinoma awareness ```

Question 27

Who should be treated for chronic infection?

Answer 27

HCV RNA present | HBsAG and Hep B DNA present

Question 28

When should hepatitis be treated?

Answer 28

Before complications | When evidence of inflammation

Question 29

What are the adverse effects of peginterferon?

Answer 29

Flu like symptoms Thyroid disease Autoimmune disease Psychiatric disease

Question 30

What are the virological benefits of chronic hep B therapy?

Answer 30

Reduction in HBC DNA (suppression) Loss of HBeAg Loss of HBsAg (cure)

Question 31

What are the other benefits (not virological) of hep B treatment?

Answer 31

``` Imrpoved liver biochemistry Improved histopathology Reduced infectivity Reduced progression to cirrhosis and primary HCC Reduced mortality ```

Question 32

What are the principles of HCV therapy?

Answer 32

Genotype of virus and viral load Genotype of patients interferon response genes Stage of disease Past treatment experience