Hepatitis

Question 1

Hepatitis A

Answer 1

Acute
Fecal oral
Travellers
Vaccine is available 
IgM - infection
IgG - recoverinG

Question 2

Hep E

Answer 2

Acute
Fecal oral
IgM infection 
IgG- recovering
Can become fulminant hepatitis
Avoid by boiling and purifying water, cooking meat

Question 3

Hep C

Answer 3

Acute or chronic
Sex, needles and birth
No vaccine 
Drugs = sovaldi and harvoni
RNA / PCR

Question 4

Hep D

Answer 4

Co-infection with Hep B
Co-infection at the same time
Superinfection is where Hep D comes after or during Hep B infection but not at same time

Question 5

Hep B

Answer 5

Chronic
20% go on to become fulminant 
hepatocellular carcinoma and cirrhosis risks
Vaccines available
Sex, needles and childbirth
Antigens - surface, envelope, core, DNA
Antibodies - surface, core

Question 6

What are the stages of Hep B infection?

Answer 6

1. Surface antigen (supervillain) is detected
2. Envelope and RNA is made, and core antigens (factory/ core workers)
3. Window phase with IgM anti-Cag - all low - don’t know who will win
4. Outcomes could be IgG anti-Sag, followed by IgM to IgG anti-cab
5. Or chronic infection with IgM and high RNA and antigens
6. Or latent infection with low IgG and low antigens

Question 7

What blood tests for Hep B?

Answer 7

ALT>AST
Both high
bilirubin

Question 8

What are the serotypes of hepatitis E? Which one is non-endemic?

Answer 8

1-4

3 is non-endemic

Question 9

What are some complications of HEV?

Answer 9

Neurological:
– Guillain-Barre Syndrome
– Bell’s Palsy
– Acute transverse myelitis
– Meningioencephalitis
 Kidney Injury: Membranoprolefertaive and membranous
glomerulonephritis
 Pancreatitis mainly with HEV 1
 Haemolytic Disorders
– Thrombocytopenia
– Aplastic anaemia

Question 10

What is some management for HEV?

Answer 10

Treatment:
– Reduction of immunosuppression – clearance in nearly one
third of patients
– Ribavirin
– Pegylated Interferon
 Prevention:
– Sanitation, clean water
– Avoiding eating undercooked meet
– Vaccines:
 VLP of E2 domain of HEV 1 capsid protein generated in
E Coli. Licensed for use in China
 VLP of E2 domain of HEV1 capsid protein generated in
insect cells. Phase 111 trial in Nepal

Question 11

How many genotypes of HEV?

Answer 11

4

Question 12

Who should have the HAV?

Answer 12

Travelling to or going to reside in areas of high or intermediate prevalence
– Patients with chronic liver disease
– Patients with haemophilia
– Men who have sex with men
– Injecting drug users
– Individuals at occupational risk i.e. laboratory workers, staff of some large
residential institutions, sewage workers, people who work with primates

Question 13

Globally what are the main causes of death from liver disease?

Answer 13

 HBV 39%
 HCV 19% (fallen from 25% in 2000)
 alcohol 24%
 other causes 18%

Question 14

Who is screened for HBV?

Answer 14

Blood and organ donors
• Healthcare workers
• Pregnant women
• Dialysis patients
• GUM clinic attendees
• IVDU/prisoners

Question 15

How common is co-infection of HDV with HBV?

Answer 15

Co-infection in 10% chronic HBV infection in UK

 Migrants from high prevalence countries

Question 16

What are the main treatments for HDV and HBV?

Answer 16

Interferons and nucleoside analogues:
Pegylated IFN alpha-2a
Entecavir
Tenofovir

Question 17

What type of virus is HDV?

Answer 17

Delta virus

Question 18

What is the natural history of HCV?

Answer 18

20% natural clearance, 
20% get chronic hepatitis at 20
50% get chronic hepatitis at 30
fulminant hepatitis 1%
hepatocellular carcinoma 
cirrhosis

Question 19

How was HCV treated?

Answer 19

Ribavirin and interferon

Question 20

How many serotypes are there of HCV?

Answer 20

6