Hepatitis Flashcards
Hepatitis A transmission
Faecal-oral spread, poor hygiene
Investigation
Clotted blood for serology (Gold top), hepatitis A IgM
Control of hepatitis A
Hygiene, vaccine prophylaxis
Where is hepatitis E more common?
Tropics
Hepatitis E transmission
Faecal-oral transmission
Cases of hepatitis E in the UK are thought to be what?
Zoonoses
Hepatitis D - which other hepatitis virus is it found with?
Hepatitis B
Clinical significance of hepatitis D
Exacerbates hepatitis B
Transmission of hepatitis B
Sex, mother to child, blood to blood
People at higher risk of hepatitis B
People born in areas with higher prevalence, multiple sexual partners, PWID, children of affected mothers
Which test can differentiate acute from chronic infection of hepatitis B?
IgM test
What indicates low infectivity in hepatitis B?
Anti-HBe
What is present in the blood of all individuals affected with hepatitis B?
HBsAg - hepatitis B surface antigen
Which antigen is present in highly infectious individuals with hepatitis B?
HBeAg - hepatitis B e antigen
What present in high titre in highly infectious individuals with hepatitis B (not antigen)
Hepatitis B DNA
What is most likely to be present in recently affected individuals with hepatitis B?
Hepatitis B IgM
What is present in patients with immunity to hepatitis B?
Anti-HBs
Clinical course of chronic hepatitis B infection
Immune tolerance, immune clearance, immune control, immune escape
Immune tolerance in hepatitis B infection:
- HBV DNA level
- LFTs
- Hepatitis B e antigen
- Treatment
- High HBV DNA level
- Normal LFTs
- Hepatitis B e antigen positive
- Monitor every 6-12 months
Immune clearance in hepatitis B infection:
- HBV DNA level
- LFTs
- Hepatitis B e antigen
- Treatment
- High HBV DNA level
- Abnormal LFTs
- Hepatitis B e antigen positive
- At risk of progression to cirrhosis and hepatocellular carcinoma so should be referred for consideration of treatment
Immune control in hepatitis B infection:
- HBV DNA level
- LFTs
- Hepatits B e antigen
- Treatment
- Low HBV DNA level
- Normal LFTs
- Hepatitis B e antigen negative
- Monitor every 6-12 months
Immune escape in hepatitis B infection:
- HBV DNA level
- LFTs
- Hepatitis B e antigen
- Hepatitis B e antibody
- Treatment
- High HBV DNA level
- Abnormal LFTs
- Hepatitis B e antigen negative
- Hepatitis B e antibody positive
- At risk of progression to cirrhosis and hepatocellular carcinoma therefore should be referred for consideration of treatment
Control of hepatitis B
Minimise exposure, pre-exposure vaccinations UK, post-exposure prophylaxis
Steps taken to minimise exposure of hepatitis B
Safe blood, safe sex, needle exchange, prevention of needlesticks, screening of pregnant women
Who is given a vaccine for hepatitis B?
All children born after 1st August 2017 and at risk older children and adults
Post exposure prophylaxis in hepatitis B
Vaccine, hyperimmune hepatitis B immunoglobulin
Transmission of hepatitis C virus
Mother to child, blood to blood, sex (but less easily transmitted)
Outcome of hepatitis C virus
Asymptomatic for years until they develop signs of chronic liver disease
Hepatitis C control
Minimise exposure
How long does of been affected defines chronic?
6 months
Typical time from hepatitis infection to cirrhosis
> 20 years
Typical time from hepatitis to hepatocellular carcinoma
> 30 years
Management of acute viral hepatitis
Monitor for encephalopathy and resolution, notify public health, immunisation of contacts, test for other infections
Management of chronic viral hepatitis
Antivirals, vaccination of other hepatitis viruses, infection control, decreased alcohol consumption, hepatocellular carcinoma awareness/screening
Screening for hepatocellular carcinoma
Serum-alpha fetoprotein and ultrasonography
Chronic HVB therapy
- Adefovir – commonly used
- Entecavir – commonly used
- Tenofovir
- Lamivudine – nucleoside analogue reverse transcriptase inhibitor
- Telbivudine – nucleoside analogue reverse transcriptase inhibitor
- Interferon alfa
Chronic HVC therapy
- Peg interferon alpha, usually given with ribavirin
- Boceprevir or telaprevir licensed to be given with peginterferon alfa and ribavirin in genotype 1 infection.
- Sofosbuvir
- Ledipasivir
- Daclatasivir
Dabasuvir - Ombitasivir / paritaprevir
- Simeprevir
When to treat chronic viral hepatitis
Hepatitis B with raised ALT and high HBV DNA, treat when the patient is ready, chronic hepatitis C treated right away
Interferon alpha:
- What is it?
- What is it given by?
- Side effects
- Human protein that is part of the immune response to viral infection
- Injection as pegylated interferon
- Chills, sore muscles, malaise, thyroid disease, autoimmune disease, psychiatric disease
First option for treatment for hepatitis B:
- What is it?
- Examples
- Advantages
- Disadvantages
- Suppressive antiviral drug
- Entecavir, tenofovir
- Safe, increasing range available
- Causes suppression but not cure, resistance can develop
Second option for treatment in hepatitis B:
- What is it?
- Advantages
- Disadvantages
- In which patients should this be tried?
- Peginterferon alone
- Sustained cure possible from a few months of therapy
- Side effects, injections
- HBsAg and HBeAg positive patients with compensated
Definition of response in chronic hepatitis C infection
Loss of HCV RNA in blood sustained to 6 months after the end of therapy
Current antivirals used for hepatitis C
Simeprevir, ledipasvir, daclatasvir, ombitasvir, paritaprevir, elbasvir, grazoprevir, sofosbuvir, voxilaprevir, velpatasvir, pibrentasvir, glecaprevir
