Chronic Hepatitis

Question 1

How long does the hepatitis have to go on for before it is classed as chronic?

All hep viruses except A all cause chronic hepatitis.

B and C cause chronic H.

D and E don’t usually.

• When does D only infect?
• What type fo patient can E become chronic in?

Answer 1

> 6 months

D - with HBV

Only immunosuppressed

Question 2

Hep B:

There are stages to chronic hep B. What happens during the periods of active hepatitis?

Drugs to treat if chronic:

Nucleotide analogues:

• Example?
• What do they inhibit?

Indications for Rx?

Why would it be given in pregnancy?

Answer 2

Liver disease progression

Entcavir/Tenofovir

Inhibits viral DNA polymerase

Patients with pre-existing liver disease
FH of HCC/cirrhosis
Co-infection with HIV

Reduce vertical transmission

Question 3

Hep D:

What is the different between co-infection and super- infection?

Why is it important to know if they have a co-infection?

What serological test is used to diagnose? - 2

How to treat?

Answer 3

HDV RNA

Co-infection - infection at the same time as HBV infection

Super infection - infection after HBV infection

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There is a more rapid progression to cirrhosis and HCC
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Anti-HDV antibodies - HD antibodies (screening)

Treating Hep B

Question 4

Hep C:

Same transmission as Hep B. What types then?

There are different genotypes which are common in different areas of the world.

Why is it important to know the genotypes? - 2

Answer 4

Needlestick injuries
IVDU
Blood products
Tattoos/acupuncture

No cross-protection between genotypes - people can be co-infected by more than 1

Some Rx are genotype specific

Question 5

Hep C vs Hep B:

Which one is more likely to be asymptomatic?

Does Hep C progress slower or faster to cirrhosis and HCC?

Cure is possible in C unlike B

Does Hep C have a vaccine?

Answer 5

Hep C

Slower for Hep C

No Vaccine for Hep C

Question 6

Hep C:

Diagnosis:

(1) HC antibody measured - why is a disadvantage of this test?

(2) Hep C RNA:
- What is used to detect the RNA?
- Why is it important to do?

Treatment:

Direct Acting Antivirals (DAAs) - all patients treated

What can be tested to make sure they are cured?

Answer 6

If found, suggests CURRENT infection!

Cannot differentiate current vs past hepatitis C infection

PCR

HC RNA

Question 7

Hep E:

What type of patient can hep E be chronic in?

Genotypes - 3/4

What drug can be given as treatment?

How do diagnose it?

Answer 7

If they are immunosuppressed

Ribavirin

HEV RNA PCR