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