Hepatitis

Question 1

How is HAV transmitted

Answer 1

Faeco oral route

Question 2

When is HAV infectious?

Answer 2

2 weeks before and 1 week after jaundice by non parenteral routes
Virus in blood and stool until amino transferase levels have peaked
HIV+ viraemia may last >90 days

Question 3

Incubation HAV

Answer 3

15-45 days

Question 4

Symptoms of acute HBV

Answer 4

Infants and children mostly asymptomatic

10-50% adults asymptomatic (and more likely confection HIV)

2 symptomatic phases:
Prodromal: flu like sx plus RUQ pain
Icteric: mixed hepatic and cholestatic plus nausea anorexia and fatigue. Can persist more than 12 weeks if cholestatic sx (itching and deep jaundice)

Question 5

Signs acute HBV

Answer 5

Prodromal: Non specific
Icteric: jaundice pale stools dark urine, liver enlargement and tenderness, dehydration

Question 6

Complications of acute HBV

Answer 6

Acute liver failure < 1%
Severe hepatitis
Acute in Pregnancy: miscarriage, prem labour, vertical transmission
Mortality <1%
Chronic infection

Question 7

Complications HAV

Answer 7

ALF <0.4%
15% may require hospital admission
Very rare chronic infection
Mortality <0.1% but rises to 40% in ALF (consider liver transplant)
Pregnancy incr risk miscarriage and prem labour

Question 8

Incubation period HBV

Answer 8

40-160 days

Question 9

Signs of chronic HBV infection

Answer 9

None
Spider naevi
Finger clubbing
Hepatosplenomegaly
Jaundice
Severe: thin skin, ascites, liver flap, encephalopathy

Question 10

Risks associated with chronic HBV and HIV

Answer 10

Reactivation HBV in advanced HIV

Increased risk progression to cirrhosis, liver Ca and death

Question 11

Risk of vertical transmission of HBV

Answer 11

If no intervention at birth (vaccination or immunoglobulin)
90% with HepB e antigen positive HBeAg
10% HBs antigen positive HBsAg

90% untreated infants will become chronic carriers

Question 12

How is HBV transmitted?

Answer 12

Sexually
Vertical
Parenteral (shared needles and other drug paraphernalia, infected blood product, needlestick)

Question 13

Management HBV

Answer 13

STI screen
Screen Hep A, C, D
Vaccinate HAV
PN

Question 14

When is HBV infectious?

Answer 14

2 weeks prior to jaundice until HBsAg negative

Question 15

Who to screen for HBV?

Answer 15

MSM
CSW
PWID
HIV+
Victims of SA
Endemic areas (outside W EU, N America, Australasia)
Neddlestick injury
>10 partners/yr
Partners of positive or high risk

Question 16

Who should be screened for HCV?

Answer 16

PWID
HIV+
MSM eligible for 3 monthly testing
Those eligible for or taking Prep
Haemophilia or other blood products pre 1990
Needlestick
Sexual partner of HCV+
CSW
Alcoholics
Migrants from Endemic countries 
Ex prisoners
Tattoo recipients

Question 17

Vaccination schedules for HBV

Answer 17

Ultra rapid 0, 1, 3 weeks plus 12 months
Accelerated 0, 1, 2 months plus 12 months
Standard 0, 1, 6 months

HIV+ double dose 40 ug Energix ot HBVaxPro at 0, 1, 2, 6 months
Only use ultra rapid if CD4>500
4-8 wks post completion of titre <10 give 3 further doses monthly
If >10 <100 give booster dose

Question 18

What is HDV?

Answer 18

Delta virus Incomplete RNA virus only coinfects HBV
Worsens prognosis HBV. High rate fulminant hepatitis and progression to cirrhosis
Response to anti viral therapy is poor