154b - Clinical Features of Viral Hepatitis (Only including things not in Sketchy)

Question 1

Can hepatocellular carcinoma occur in patients without cirrhosis?

Answer 1

Yes

Especially in the setting of chronic HBV

Question 2

What do the following serology results tell you about a patinet’s immune status?

Is there anything else you need to know to be sure?

(+) anti-HBc total

(-) anti-HBc IgM

Answer 2

Chronic HBV infection likely

• Anti-HBc IgM falls as the immune system loses to the virus
• Anti-HBc Total remains positive - this is IgG
• (+) HBsAG would confirm chronic infection
  
  • Although, (-) HBsAG does not rule out ongoing infection; may be “low-level” chronic or resolving acute infection

Question 3

Which patients are most likely to develop chronic HBV infection?

Answer 3

Exposed as young children

Acute infection with mild or no symptoms

Question 4

Which hepatitis virus is most likely to develop into a chronic infection?

Answer 4

HCV

Question 5

List 4 possible interpretations of the following serology:

HBs (-)

Total anti-HBc (+)

Anti-HBs (-)

How would you manage this patient?

Answer 5

• Resolved infection
  
  • But for some reason no anti-HBs
• “Low level” chronic infection
• Resolving acute infection
  
  • Window period
• False positive for anti-HBc

Check HBV viral load; if high would confirm infection

Either way, supportive care

Question 6

Which HBV patients should be treated with antiviral therapy?

Answer 6

• Patinets with chronic HBV with:
  
  • High viral load
  • Anti-HBc IgM (-)
    
    • May have Anti-HBc IgG (+)
• Pregnant patients with high viral load

Give PO tenovofir, or Entecavir if not pregnant

Question 7

What are 3 risk factors for HbA

Answer 7

1) . Poor sanitation
2) . IV Drug use
3) . Homelessness

(anything that gets you exposed through fluids)

Question 8

How do you determine the status of a suspected HBV patient?

Answer 8

1) . Order serologies : IgM/total (if ever infected) + sAg&sAb (acute infxn, still resolving)
2) . Viral Load and eAg/eAb = infectivity possibility

Question 9

Why is treatment not given to all chronic HBV patients?

Answer 9

Treatment only lowers viral load; it DOESN’T DEVELOP IMMUNE RESPONSE

Sometimes, it’s weighing whether a less-symptomatic HBV condition is worth dealing with than constantly getting antivirals

Question 10

Who should be tested for HCV infection?

Answer 10

All individuals 18+ yo

Question 11

What is the essential HBV component for HDV replication?

Answer 11

HDV requires the sAg acquired from previous HBV infxn. Otherwise, the patient cannot get HDV

Question 12

Which population has high risk mortatli yif exposed to HEV?

Answer 12

HEV = acute viral infxn so similar to HAV factors (homelessness, poor sanitation, etc.)

But additionally:

1) . Pregnant patients (high 3rd trimester mortatliy)
2) . Organ transplants (HEV GT3 = chronic infxn association)