Hepatitis

Question 1

Autoimmune hepatitis epidemiology

• age of onset
• gender most affected
• HLA associations

Answer 1

Bimodal 15-25 and 45-60
F>M
HLA class 1 B8, HLA class 2 DR3, DR52a. In asians HLA DR4

Question 2

Autoimmune hepatitis

• symptoms
• labs
• types and their Abs

Answer 2

fatigue and jaundice
Elevated transaminases early, then bilirubin and ALP rise in more advanced disease
Elevated total IgG
Type 1 - > 1:80 titre of: ANA, anti-smooth muscle, antiactin, anti-asialoglycoprotein receptor.
Type 2 - anti-liver-kidney microsomal 1 antibodies and anti-liver cytosol 1 antibodies

Question 3

Drug induced hepatitis

- types of injury

Answer 3

Hepatocellular
Cholestatic
Immunoallergic
Steatohepatitis

Question 4

HepA

• nucleic acid type
• route of transmission
• ?chronic infection
• treatment

Answer 4

RNA
faecal oral route
no
supportive

Question 5

HepB

• nucleic acid type
• route of transmission
• ?chronic infection
• treatment

Answer 5

DNA
Vertical, sex, IVDU/drugs, close contact
Yes, most common in those infected perinatally
Nucleot(s)ide anologues - Entecavir, Tenofovir fumarate, Tenofovir alafenamide

Question 6

Hep C

• nucleic acid type
• route of transmission
• ?chronic infection
• treatment

Answer 6

RNA
Mostly IVDU, rarely sexual
Yes
DAA

Question 7

HepD

• nucleic acid type
• route of transmission
• ?chronic infection
• treatment

Answer 7

RNA
Concurrent with HepB (defective virus requires HepB)
Yes
Suportive

Question 8

HepE

• nucleic acid type
• route of transmission
• ?chronic infection
• treatment

Answer 8

RNA
Faecal oral route
Rarely, most severe in pregnant women
Ribavirin in fulminant hepatitis

Question 9

What percentage of those exposed develop chronic infection in those:

• infected perinatally
• immunocompetent adults

Answer 9

> 90%

<5%

Question 10

What percentage of chronic HepB infected people develop:

• HCC
• Cirrhosis
• Decompensated liver failure

Answer 10

5-10%
>30%
23% (within 5 years of developing cirrhosis)

Question 11

Who should be screened for HepB? (11)

Answer 11

people born in endemic areas
ATSI
Pregnant women
MSM
IVDU
Sex workers
HD patients
Other STIs
Sexual or household contacts
Prior to immunosuppressive therapy
Elevated ALT/AST without identifiable cause

Question 12

What are the stages of hepatitis B infection?

Answer 12

1. Immune tolerance
2. Immune clearance
3. Immune control
4. Immune escape

Question 13

What are the treatments for Hepatitis B
Who are they offered to
Which is safe in pregnancy
Which is safe in renal disease
Which is avoided in bone disease

Answer 13

Entecavir, Tenofovir disoproxil fumarate (TDF), Tenofovir alafenamide (TAF)
Those who are not in immune control phase
TDF
Entecavir
Entecavir

Question 14

What percentage of people:

• do not know they have HepC
• clear the virus within 2-6 months
• develop chronic hepatitis
• develop liver damage
• develop cirrhosis
• develop HCC

Answer 14

50% do not know they have HepC
25% clear the virus within 2-6 months
75% develop chronic hepatitis
55% develop liver damage
5-20% develop cirrhosis
2-5% develop HCC

Question 15

What are the classes of DAA for HepC?

Answer 15

Protease inhibitor
NS5A inhibitor
RNA polymerase inhibitors

Question 16

How much does HepD increase the risk of cirrhosis in those with HepB?

Answer 16

4-fold increase in risk