Hepatitis B and other viral hepatitis Flashcards
Immunologic markers of HBV infection
HBsAg
HBsAb
HBcAb
HBeAg
HBeAb
Markers of acute HBV infection
HBsAg
HBcAb
HBeAg
Recovery from acute –> formation of Ab
Markers of chronic HBV infection
HBsAg
HBcAb
HBeAg or HBeAb depending on immune control
Markers of cleared HBV infection
HBsAb
HBcAb
HBeAb
Highest risk of chronic HBC infection and HCC risk?
Infection at birth from a HBeAg positive mother
Factors associated with increased rates of cirrhosis and HCC
Older age EtOH Co-infection with HCV, HDV or HIV Smoking Male HCC family history
Treatment options for HBV
Entecavir, Tenofovir and pegIFN
When should patients be treated?
Compensated cirrhosis with HBV DNA >2000
Decompensated Cirrhosis with any detectable any of HBV DNA
HBV DNA positive and undergoing chemotherapy or immunotherapy
All others can be observed but treatment is preferred
HBV and pregnancy
All pregnant women should be tested
All newborns receive HBV vaccine at birth
Newborns with HBV positive mothers should receive passive immunisation with HBIG at birth
If pregnant mothers have high DNA levels>100 consider HBV treatment in the 3rd trimester
Rare syndrome associated with lamivudine and adefovir treatment
Fanconis syndrome
Low glucose Low PO4 Low Amino acids Low K --> metabolic acidosis
Hepatitis D
Small defective RNA virus
Requires HBsAg for transmission and packaging
Associated with more severe hepatitis and higher mortality
Treatment = pegIFN for at least 48 weeks
Hepatitis E
RNA virus
Diagnosis = HEV RNA
Food and waterbourne virus –> severe hepatitis
Pig meat = reservoir
High mortality in immunocompromised and pregnancy
When can’t entecavir be used?
Previous treatment with lamivudine
High risk of resistance –> treatment failure
Aim of treatment of HBV?
Only with Peg IFN or E antigen negatively
Aim = E antigen positivity
