Hepatitis Flashcards
What are the WHO targets to eliminate hepatitis by 2030?
Sustainable development goal to combat viral hepatitis
Vaccinate infants
Reduce MTCT
Blood and needle safety in healthcare
IVDU harm reduction
Increase diagnosis of Hep B+C (target at risk groups)
Increase Tx of HepB+C
Globally what is the most common cause of hepatitis?
Hepatitis E
What is the leading cause of HCC worldwide?
Hep B
What are the relative risks of BBV transmission from needlesticks?
Hep B 30%
Hep C 3%
HIV 0.3%
How is hepatitis A transmitted?
Faecal-oral- outbreaks
What are the features of hepatitis A infection
Acute but mild
Children often asymptomatic
Leads to immunity
How do you diagnose hepatitis A
PCR
What is the vaccination schedule for hep A
2 doses leading to 10yr immunity
Inactivated virus
How is Hepatitis E transmitted?
Faecal-oral
Undercooked sausage/shellfish
What are the features of hepatitis E infection?
Can become chronic if Immunosuppressed
Can get fulminant if pregnant with high mortality
How do yo diagnose hepatitis E
PCR
IgG and IgM
How do you manage hepatitis E
Supportive
Can give ribavarin
How is hepatitis B transmitted
Mother to child - high in SE Asia and Africa
IVDU
Sexually
What are the features of hepatitis B
Prodrome
Acute hepatitis (ALT>10,000)
Chronic hepatitis (95% if vertical transmission)
HCC
How do you diagnose hep B
HBsAg- have HepB
HBeAg-infectious
HBV DNA
HbsAb- vaccinated or have HepB
HbcAb- have or had HepB
How do you manage hep B
Check HIV- tenofovir and lamivudine
If cirrhosis : tenofovir or entecavir(kids)
If over 30, persistently abnormal ALT and HBV DNA >20,000: tenofovir or entecavir
How do you monitor HepB
Detection of HCC every 6months
ALT, HBV DNA, HBeAg, renal function every 12 months
When can you stop HepB treatment?
No cirrhosis and
HbeAg loss and conversion to anti-HBe after completion of at least one additional year of Tx
And persistently normal ALT
And persistently undetectable HBV DNA
What is the vaccination for hep B
3 doses inactivated HBsAg
If born to HBV +ve mum then first dose should be at birth
What is the management of pregnant women with HepB?
Tenofovir in T3
How is hepatitis C transmitted?
Blood
MSM
MTC
What are the features of hep c?
1/5 will clear infection
4/5 will become chronic, 20%cirrhosis
HCC
How do you diagnose hepC
HCV RNA
HCcAg
HCV Ab- previous exposure
How do you manage hep C?
Sofosbuvir/velpatasvir for 12 weeks
Assess for cure (HCV RNA) 12 weeks post Tx
Monitor for HCC every 6months in those with cirrhosis
Don’t treat in pregnancy, baby will have HCV RNA test at 18months
