Hepatitis B (And D) and C

Question 1

Why are hepatitis B and C the most important?

Answer 1

They lead to chronic infection with carrier status. Worldwide they are the commonest causes of death and primary hepatocellular carcinoma

Question 2

How is the majority of hep B transmitted?

Answer 2

Vertically from mother to child but it can be transmitted horizontally.
Virus particles cannot pass to the foetus but non infectious viral proteins can. These will cause the foetus to form an immune response against the virus.
When the baby is born it will be exposed to the virus in birth. As it already has antibodies against the virus it will not be symptomatic and will just go on to develop the chronic infection. If the baby is vaccinated at birth it can prevent this.

Question 3

How does the risk of becoming a chronic hep B carrier change with age?

Answer 3

It decreases with age. Almost all babies who have the disease will become chronic carriers but only 5% of adults will

Question 4

What screening exists for hep B in the UK?

Answer 4

There is screening of hep B in helathcare proffesionals , pregnant women, dialysis patients, prison inmates etc
HBV testing is being introduced for all first generation migrants from countries where hep B is endemic

Question 5

How is Hep B managed?

Answer 5

It is an RNA reversetranscriptase virus so it is treated with antiviral nucleoside analogues, which block reverse transcriptase so suppress but do not eliminate the virus
Can also be treated with interferons particularly interferon alpha

Question 6

How is hep C most commonly transmitted?

Answer 6

Through blood products such as needles

Question 7

What is a typical hep C history?

Answer 7

Will commonly be asymptomatic until later on in the disease. Will rarely show jaundice

Question 8

What determines the rate of progression of Hep C to cirrhosis?

Answer 8

The rate of progression to cirrhosis is determined by many factors. This includes age at diagnosis, gender, alcohol intake, ethnicity, and liver function tests.
Co infection with HIV greatly increases the risk

Question 9

What is current Hep C treatment?

Answer 9

Polymerase inhibitor sofosbuvir and 5 alpha reductase inhibitor ledipasvir. Given over the course of 12 weeks has a high cure rate