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GUM/HIV > Hepatitis > Flashcards

Hepatitis Flashcards

1
Q

What is % response to ultra rapid Hep B vaccination course?

A

HebBsab response in 80% at 4-12 weeks post course
Can offer 3 further doses to other 20% but most would eventually respond
Response increases to 95% with booster

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2
Q

What is the ultra rapid Hepatitis B vaccine schedule?

A

0, 7 days, 21 days

Booster at 12 months

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3
Q

What is the rapid (post exposure) Hepatitis B vaccine schedule?

A

0, 1 m, 2m

Booster at 12 m

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4
Q

What is the standard Hepatitis B vaccine schedule?

A

0, 1m, 6m

Booster 12m

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5
Q

What are some of the associated factors for increased risk of hepatitis C?

A

Presence of other STIs (particularly syphilis and LGV
Traumatic anal sex
Fisting
shared sex toys
group sex, serosorting
Concomitant use of recreational drugs (including injected recreational drugs such as crystal methamphetamine in ‘chem-sex’ party settings).

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6
Q

How often should hepatitis C be tested for in MSM

A

Hepatitis C testing should be offered at least annually to men eligible for three-monthly HIV testing and those taking or eligible for PrEP

HIV-positive MSM should be routinely screened for HCV at least annually

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7
Q

Causes of raised bilirubin?

A

Normal levels are 3-17
Jaundice- levels over 40
Obstructive liver disease (usually also raised ALP and GGT)

Gilbert’s disease
Haemolysis
Atazanavir

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8
Q

What is the risk of vertical transmission in Hepatitis B?

A

90% of pregnancies where the mother is hepatitis B e antigen positive
10% of surface antigen positive, e antigen negative mothers.

Most (>90%) infected infants become chronic carriers

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9
Q

What can be done to prevent hep b infection to babies born to Hep B positive mums?

A

Infants born to infectious mothers are vaccinated from birth.

Hepatitis B specific Immunoglobulin 200 i.u. IM is also given in certain situations where the mother is highly infectious

This reduces vertical transmission by 90%.

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10
Q

Can Hep B positive Mum be treated in pregnancy to reduce the risk of transmission?

A

Tenofovir monotherapy can be considered for pregnant women with HBV DNA >107 IU/ml in the third trimester

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11
Q

Can Hep B positive Mum breastfeed?

A

Yes

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12
Q

% of MSM needed to vaccinate against Hepatitis A to prevent an outbreak?

A

70%

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13
Q 
Diagnosis?
HBsAg +
HBeAg +
Anti HBc IgM +
Anti HBc IgG +
HBV DNA +
HBeAb -
HBsAb -
A

Acute Hepatitis B

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14
Q 
Diagnosis?
HBsAg +
HBeAg -
Anti HBc IgM +
Anti HBc IgG +
HBV DNA -
HBeAb +
HBsAb -
A

Resolving Hepatitis B infection

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15
Q 
Diagnosis?
HBsAg +
HBeAg +
Anti HBc IgM -
Anti HBc IgG +
HBV DNA +
HBeAb -
HBsAb -
A

Chronic

Highly infectious Hepatitis B

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16
Q 
Diagnosis?
HBsAg +
HBeAg -
Anti HBc IgM -
Anti HBc IgG +
HBV DNA +
HBeAb +
HBsAb -
A

Chronic Hepatitis B

Low infectivity

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17
Q 
Diagnosis?
HBsAg -
HBeAg -
Anti HBc IgM -
Anti HBc IgG +
HBV DNA -
HBeAb +
HBsAb +
A

Resolved immune Hepatitis B

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18
Q 
Diagnosis?
HBsAg -
HBeAg -
Anti HBc IgM -
Anti HBc IgG -
HBV DNA -
HBeAb -
HBsAb +
A

Hepatitis B vaccination

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19
Q

How is Hepatitis C transmitted in pregnancy?

A

It is thought that hepatitis C is transmitted via the placenta rather than through the birth canal.

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20
Q

Risk of vertical transmission of hepatitis C

A

LOW RATE

~5% (7% if HIV coinfection)

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21
Q

Incubation of hepatitis c?

A

4-20 weeks (1-5 months)

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22
Q

What % of people with hepatitis C infection become chronically infected?

A

80%

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23
Q

How many with acute hepatitis C have symptoms?

A

20%

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24
Q

How many people with hepatitis C go on to develop cirrhosis?

A

10-20% after 20- 30 years

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25
Q

What is the annual rate of developing HCC in patient with hep c cirrhosis?

A

1-5%

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26
Q

What is the most common genotype in hepatitis C in UK?

A

Genotype 1
G1 (more common blood
G3- IV drug use)

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27
Q

How long until hepatitis C antibody becomes positive?

A

3 months

If recent exposure can do RNA

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28
Q

Why might someone not develop a HCV antibody?

A

If they have HIV or are immunosuppressed

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29
Q

What findings on fibroscan might indicate fibrosis or cirrhosis?

A

> 9.6 kpa- fibrosis
14 kpa- cirrhosis
(metavir scores)

30
Q

What advice for MSM who have chronic hepatitis C?

A 
condoms
gloves for fisting
avoid lube/group sex
Single person sex toys
advise disclosure
31
Q

Length of duration for hepatitis C DAA?

A

8-12 weeks

32
Q

Types of HCV drugs?

A

NS3/4a inhibitors- PREVIR
NS5A inhibitors- SVIR
NS5B inhibitors- BUVIR

33
Q

What type of virus is hepatitis C?

A

single stranded RNA

34
Q

Other causes of hepatitis?

A 
Viral hepatitis
Autoimmune
Haemochromatosis 
Syphilis
EBV/CMV
35
Q

what type of virus is hepatitis B

A

Double stranded DNA

36
Q

How many genotypes does Hepatitis B have?

A

A-F (6)

37
Q

Incubation of hepatitis b?

A

1-6 months

38
Q

Definition of chronic hepatitis b?

A

> 6/12 HBsAg positivity

39
Q

How many with Hepatitis B get cirrhosis?

A

8-20% over 5 years

40
Q

How many with hepatitis B cirrhosis get decompensated liver disease

A

20% over 5 years

41
Q

Treatment of hepatitis B?

A

DAA
Or pegylated interferon
Depends on genotype

42
Q

Baby born to mom who is Hep B eag positive

A

Immunoglobulin and vaccine rapid schedule decreases transmission to baby by 90%

43
Q

acute viral hepatitis investigations

A 
lft
clotting
hav igm 
hep b sag 
hcv ab and rna
hev

inform PH

44
Q

treatment Hep A

A 
supportive 
self limiting
flu like coryzal 
never chronic 
vaccine for close sex- 4 weeks before or house contacts 
vaccine works within 7 days
otherwise. an offer ig if worried about fulminant- rare
infectious 2 weeks after i’ll see
most infectious before 1-2 weeks
45
Q

treatment HEV

A

supportive

ribavarin

46
Q

chronic hepatitis B treatment

A

depends on age ALT, dna
status of cirrhosis orfibrosis
or coinfection

treat any age or stage if vl more than 20000 and abnormal alt over 30

treat more aggressively if younger <30
vl >2000

47
Q

treatment of decompensated liver disease

A

NRTI
entecavir
tenofovir

48
Q

treatment hep b. compensated liver disease

A 
pegylated interferon
cytokines class
interferes with viral replication

side effects

need contraception and men can’t conceive for -2 weeks

<40% success
48 weeks treatment

usually give entecavir or tenofovir instead

can add in lamivudine if not responding

49
Q

Acute hepatitis how long is symptomatic prodrome?

A

Symptomatic Prodromal 1-3 weeks

50
Q

Acute hepatitis how long is icteric phase?

A 
Icteric Phase 2-24 weeks
• Fever
• Jaundice
• Pale stools
• Malaise
• High ALT, high bilirubin
51
Q

Signs of liver failure on bloods?

A

Liver failure:

• High ALT, high bilirubin • +INR>1.5

52
Q

Incubation of hepatitis A?

A 
4 weeks (15-45 days)
incubation
53
Q

Transmission of hepatitis A?

A

Common source outbreaks
Person to person
Contaminated food and water.
Outbreaks

Uncommon source
Exposure during travel to high endemicity areas

54
Q

Who needs hepatitis A vaccine?

A

Foreign travelers
Contacts of hepatitis A
Occupational groups (travelling)
Patients with chronic liver disease MSM(during outbreaks)

55
Q

Hepatitis B transmission?

A

Needles
Blood
Sex
Vertical

56
Q

Who to vaccinate against hepatitis B?

A 
Offer screening/vaccine to:
• MSM
• PWIDs
• HIV-positive
• HCV-positive
• Partners of PWIDs and bisexual men
• Partners/household contacts of patients with acute HBV/HBV carriers
• Sexual assault victims and others according to risk
• Sex workers

Offer screening only to:
All from HBV-endemic countries

57
Q

Factors associated with reduced response rate to hepatitis b vaccine

A

Age >40 years

Sex – female have lower response Immunosuppression eg HIV, CRF Genetic factors – HLA types

58
Q

How many with chronic hepatitis B get HCC?

A

5%-10% of chronic HBV- infected individuals

25% of those with cirrhosis

59
Q

Isolated HepB cab

A

False-positive
‘Window period’ - before anti-HBs develops
Persistent failure to develop an anti-HBs response – occult HBV infection (can be genetic mutation- can’t detect surface ag. Do RNA/HCV ag. Can consider vaccine in interim)
Loss of detectable anti-HBs – late effect

60
Q

Isolated HBsAg

A

Early acute infection

61
Q

Anti-HBs and HBsAg

A

Dissociate immune complexes HBsAg variants

62
Q

Which other tests do you need to evaluate chronic hepatitis B?

A 
Liver profile
• HBV DNA
• Ultrasound liver /abdomen
• Liver elastography (e.g.
Fibroscan)
• Hepatitis D Ab
63
Q

Hepatitis D if acquired after hep B infection (super infection)- risks?

A 
• flare of hepatitis
• Fulminant hepatic failure (5%)
• Increased risk of progression to
cirrhosis and HCC
• 80% chronic
64
Q

How common is hepatitis D?

A 
• Incomplete RNA virus
• Only in presence of HBV
infection
• 5% of those with HBV
• Worse outcomes
Acquired with HBV, acutely
• Acute hepatitis
• only 2-5% become chronic
65
Q

How to diagnose hepatitis D?

A

HDV antibodies

HDV RNA if antibody +

66
Q

Hepatitis b incubation?

A 
12 weeks (40-150 days)
incubation
67
Q

Hepatitis c incubation?

A

Incubation 8 weeks

68
Q

Transmission of hepatitis c?

A

Injecting drugs,

contaminated blood products/needles, sex (HIV+MSM)

69
Q

Most common reported risk factor in hepatitis C?

A

Most common reported risk factor is injecting drug use with sharing of drug taking equipment
• Prevalence 50% in PWID

70
Q

Risk of vertical transmission hepatitis c?

A

Mother to infant:<5% - higher if mother also HIV positive (up to 40%)

71
Q

risk of heterosexual transmission of hepatitis c?

A

HETEROSEXUAL TRANSMISSION

Total estimated risk of heterosexual transmission is low ?0.2- 2%/year

72
Q

Which tests to do if hepatitis C Ab + with follow up testing showing HCV RNA+?

A 
FBC
U&amp;E 
LFT
auto ab 
HCV genotype
USS
fibroscan
hep a ab
refer to liver specialist

GUM/HIV (25 decks)

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