Hepatitis B&C Flashcards
At risk groups - hep b
People who inject drugs Sexual contacts of high risk people Men who have sex with men Sex workers HIV, prison, STDs, vertical transmission, needle stick, haemodialysis
Global burden of hepatitis B
2 billion with past/present infection
400 million with chronic hepatitis B
100 million/year die from hep B liver disease
Risk factors for hep B disease progression
Increasing age Family history Male Hepatic inflammation/fibrosis High alcohol intake HBV genotype and viral load
Chronic hep B indication for treatment
Chronic hepatitis HBV flare Significant fibrosis Cirrhosis Decompensated cirrhosis
HBV treatment not indicated
Immunotolerant HBV
HBV inactive carrier state
Goals of HBV treatment
Permanently suppress HBV replication
Prevent or delay progression to cirrhosis
Oral nucleoside treatment HBV
One tablet / day Very few side effects Can be used for whole spectrum HBV Suppresses virus, does not eradicate Long term therapy the norm Moderate cost
Immunomodulators - treating hep B
Once weekly injections
Many side effects but usually tolerable
Cannot be used for advanced liver disease
Can clear virus in small percentage patients
48week treatment programme
Expensive
Hepatitis C prevalence
Approx 3% world pop infected
200 million people
Leading indication for liver transplant in UK
Only 1 in 5 UK cases diagnosed
Poor uk data, likely prevalence approx 1%
Who to screen for HCV
Have ever injected drugs with shared needles
Had a medical/dental procedure in country with poor sterilisation
Received blood before 1991 or blood products before 1996
Regular sexual partners of person with HCV
Live in prison
Born to a mother with HCV
Accidental exposure to high risk person/fluids
Tattoo, piercing etc where poor infection control
Natural history hepatitis C
Most asymptomatic
Most acute infections failed to clear
Few ~2% vertical transmission
Accelerated course when co-factors - alcohol, diabetes, old, HIV, other hepatitis infection
HCV outcome
Cirrhosis 10-40%
Hepatocellular carcinoma 1-4 %
Death from complication of cirrhosis 4% per year
Probability of death within one year - 33%
HCV treatment
Complicated but can achieve complete remission
New direct acting antivirals
Peginterferon
Ribavirin
Side effects - anaemia, neutropenia, depression
Contraindications to HCV therapy
Lots!
Inc psych - uncontrolled depression, psychosis, epilepsy
Uncontrolled autoimmune
Uncontrolled DM, HTN, COPD, CHF
