Hepatitis Flashcards
What is the primary route of transmission of Hepatitis B in the UK?
Sexually
IVDU
What does a positive anti-HBc (IgG) indicate?
Current OR past infection with Hep B
What does a positive anti-HBc (IgM and IgG) indicate?
If both IgM and IgG are positive, this indicates acute infection with Hep B
What is the primary route of transmission of Hepatitis B worldwide?
Vertical transmission or transmission in early childhood
Which cells in the body does Hepatitis B infect?
Human hepatocytes
What are the main complications of Hep B infection?
Liver cirrhosis
Hepatocellular carcinoma
What is a tumour marker for hepatocellular carcinoma?
Alpha-fetal protein (AFP)
What does a positive HBsAg indicate?
Current infection with Hep B - either acute or chronic
How can you differentiate between acute and chronic infection with Hep B if a person has a positive HBsAg test?
Look at the types of anti-HBc antibody
In chronic infection IgG will be positive but IgM will be negative. In acute infection, both IgG and IgM will be positive.
What does Hep B serology show in an individual who has been vaccinated?
anti-HBs positive
HBsAg negative
anti-HBc negative
Which individuals are screened for Hep B?
Blood donors
Pregnant women
GUM clinics
Drug and alcohol services
What is the standard schedule for Hep B vaccination?
Vaccination at 0, 1, and 6 months
What are the complications of co-infection with HIV in patients with Hep B?
Reduced efficacy of Hep B vaccination
More likely to convert to chronic Hep B infection
What implication does a positive HBeAg have?
High risk of infectivity
What happens to the babies of pregnant women who are positive for Hep B?
Babies are given Hep B vaccination at birth
A pregnant women has a Hep B infection and is HBeAg positive - how would you manage her?
Give Hep B immunoglobulin to reduce risk of transmission to the baby (she is at high risk of transmission due to positive e-antigen)
What serological markers are observed to check a person’s immune status against Hepatitis C?
Hep C antibody
Hep C RNA
What does a positive Hep C RNA test indicate?
Acute or chronic Hep C infection
How do you differentiate an acute Hep C infection from a chronic infection using Hep C serology?
Hep C RNA will be positive in both so look at Hep C antibodies to distinguish - in an acute infection, the antibodies will be negative as they have not developed yet (takes about 6/12), while in a chronic infection the Hep C antibodies will be positive
What does a positive Hep C antibody test indicate?
Chronic infection or previously cleared infection
How do you differentiate a chronic Hep C infection from a previous (now cleared) infection using Hep C serology?
Hep C antibodies will be positive in both so look at Hep C RNA to distinguish - In chronic Hep C infection these will be positive, while they will be negative if the infection has been cleared
True / False: Patients with Hep B are at high risk of developing hepatocellular carcinoma even if they don’t have liver cirrhosis
True - A significant proportion of Hep B patients develop HCC despite never having cirrhosis
True / False: Patients with Hep C are at high risk of developing hepatocellular carcinoma even if they don’t have liver cirrhosis
False - It is rare to develop liver cancer in Hep C if the patient doesn’t have liver cirrhosis
Is there a vaccination for Hep C?
No
How long after initial infection does it take for Hep C antibodies to develop?
About 6 months
What serological markers are observed to check a person’s immune status against Hepatitis A?
Total anti-HAV
HAV IgM
What does a positive ‘total’ anti-HAV indicate?
Either acute infection or previous infection (now immune)
How do you distinguish between an acute Hep A infection and a previous infection (now immune)?
Total anti-HAV will be positive in both cases so do anti-HAV IgM antibodies to distinguish. IgM antibodies will be positive in acute infection and negative in previous (now immune) infection
Is there a vaccination available for Hep A?
Yes - It is given to high risk (MSM) groups
Of Hep A, B, C, E…which are DNA viruses and which are RNA viruses?
DNA = Hep B RNA = Hep A, C, E
List some possible treatments for Hepatitis B
Conservative
Pegylated interferon-alpha
Other antivirals e.g. tenofevir, entecavir
