Hepatitis Types Flashcards
What is the transmission, incubation period, prevention, and symptoms of acute infection regarding Hepatitis A, B, C, D and E?
What are IgM, IgG, and Viral load for?
Regarding hepatitis A, B, and C, what do we send when it is acute & chronic infection & immunity?
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Regarding Hepatitis A (HAV), what are the key factors?
- Single stranded RNA virus
- In the picornaviridae family
- four different genotypes (doesn’t matter clinically)
- immunizations given to infants
- primarily transmitted through fecal-oral route (person to person contact, ingestion of contaminated food or water, rare parenteral transmission and in MSM).
- Shellfish
Regarding Hepatitis A (HAV), what is the pathogenesis?
• HAV is ingested
o Traverses the small intestine
o Reaches the liver via the portal vein and is taken up by hepatocytes
• Once HAV enters hepatocytes, viral RNA is uncoated
o The RNA is translated into proteins and then assembled into mature virions
o Secreted into the biliary canaliculus, then the bile duct and back into the small intestine
o Eventually excreted into feces
Regarding Hepatitis A (HAV), what are the clinical features?
• Incubation period of 2-4 weeks
• Never becomes a chronic infection
o Can rarely have a relapsing infection
o Rarely develop acute liver failure
• Fatigue, weakness, anorexia, nausea, vomiting, abdominal pain, fever, malaise, jaundice, myalgias, diarrhea
o Rare extrahepatic manifestations
Regarding Hepatitis A (HAV), what are the lab results?
• Liverchemistries o Elevated aminotransferases • Anti-HAV IgM o Positive with the onset of symptoms o Rarely lasts for more than 6 months • Anti-HAVIgG o Prior infection o Vaccination
Regarding Hepatitis A (HAV), who to vaccinate?
o Standard vaccination for children
o Can give prior to international travel if > 2 weeks before
travelling
o Occupational risk
o Chronic liver disease
o Require lifelong blood product transfusions o MSM
o IVDA
o Family and care givers of recent adoptees from countries where HAV is common
Regarding Hepatitis A (HAV), what is the treatment?
• Supportive-care
•Patients with acute liver failure may require liver transplant
• Use of hepatitis A vaccine in post-exposure prophylaxis within two weeks of exposure
o > 12 months old
• Immuneglobulin
o Can be used for post-exposure prophylaxis
Discuss what HBV is.
- HBV is the second most important carcinogen after tobacco.
- HBV is 50 to 100 times more infectious than human immunodeficiency virus type 1 (HIV-1).
- 70% of HBV-related deaths are due to hepatocellular carcinoma6
Candidates for Screening for HBV
• Persons born in high endemic areas
• Household and sexual contacts of HBsAg positive persons
Persons who have ever injected drugs
• Persons with multiple sexual partners, or history of STDs Men
who have sex with men
• Inmates of correctional facilities
• Individuals with chronically elevated ALT/AST
Individuals infected with HIV or HCV
• Patients undergoing dialysis
All pregnant women
Serologic Markers in HBV Infection
HBV Screening Algorithm
Additional Screening in a CHB Patient
Management of Patients Without Immunity
Post-Vaccination
Complications of CHB
Actuarial Survival in End-Stage Liver Disease
Monitoring CHB Patients for Viral Replication:
HBV DNA
Monitoring CHB Patients for Viral Replication:
HBV DNA
Monitoring CHB: The Role of ALT
Monitoring CHB Patients for Liver Injury:
Liver Biopsy or Elastography
Monitoring Patients for HCC: Alpha-Fetoprotein (AFP) and Ultrasound
Host and Viral Risk Factors for HCC
Candidates for Treatment for HBV
CHB Treatment Goals
According to the AASLD Practice Guidance on Chronic Hepatitis B:
The ultimate goal of CHB treatment is to prevent or reduce:
– Cirrhosis
– Hepatic failure
– Development of HCC
– Prevent MTCT (3rd trimester therapy for women with high viral load (> 200,000 IU/mL)
The aims of CHB treatment are to achieve sustained suppression of HBV replication or HBsAg seroconversion.
Candidates for Monitoring without antivirals for HBV
Discuss HCV
2012 CDC Screening Recommendations for HCV
National Strategy for the Elimination of Hepatitis B and C
A 90% reduction in incidence of HCV (relative to 2015) is possible in the US by 2030. Meeting this goal will require treatment without restrictions on severity of disease and a consistent ability to diagnose new cases even as prevalence decreases.
The same levels of diagnosis and treatment would reduce mortality from HCV in 2030 by 65% relative to 2015, and avert 28,800 deaths by 2030.
Meeting these targets depends on diagnosing at least 110,000 cases a year until 2020, almost 89,000 a year between 2020 and 2024, and >70,000 each year 20-25- 2030.
HCV in the United States 2010-2015
Reported cases of acute HCV infection increased almost 3-fold from 2010 through 2015, rising annually throughout this period.
The increase in acute HCV case reports largely reflects new infections associated due to injection-drug use
Highest rates in young, white persons in non-urban areas
An estimated 33,900 (95% CI=26,800–115,000) new HCV infections occurred in 2015.
Diagnosis of Viral Hepatitis Patients Who Have Risk Factors
A normal ALT level does not rule out chronic viral hepatitis
ALT levels may be intermittently normal in a significant number of patients who have chronic hepatitis C
Anti-HCV Antibody Tests
• 98% to 99% sensitivity
• Lower specificity, but much higher than
older generations
• May produce rare false-positive and false- negative results
• Usually positive after 12 weeksofinfection
• Inexpensive, rapid tests available (20 minutes)
Hepatitis C Virus RNA Tests
Determine the presence of actual virus, not anti- HCV antibodies
Can quantify and determine genotype
Helpful in difficult cases, when antibody tests inconclusive and for acute HCV
ALWAYS needed to confirm dx and before therapy
Determine likelihood of response to therapy, NOT extent of disease
HCV Genetic Tests
HCV Life Cycle
IFN-Free Therapy for HCV
Sustained Virologic Response (SVR) Leads to Improved Outcome
Burden of HCV Disease
Liver disease due to chronic HCV is a major cause of morbidity and mortality
Impact is expected to peak in ~ 2020
Sustained virologic response (SVR) = cure
Decreased risk of liver complications Decreased risk of death
In 2010, Institute of Medicine report noted limited awareness and called for more action to address viral hepatitis in the US
Therapies are greatly improved but will not impact outcome without increased screening and Rx
