MI: Viral Hepatitis

Question 1

How is hepatitis A spread?

Answer 1

Faecal-oral

Question 2

What is the incubation period for hepatitis A?

Answer 2

2-6 weeks

Question 3

Describe the natural history of hepatitis A infection.

Answer 3

• 2-6 weeks after the infection you will develop hepatitis (transaminitis)
• This will be accompanied by a rise in IgM
• A more gradual rise in IgG will follow

NOTE: hepatitis A infection is often subclinical

Question 4

What is the diagnostic test for hepatitis A?

Answer 4

Anti-hepatitis A IgM

Question 5

Which antibodies will be present if someone has received a hepatitis A vaccine?

Answer 5

High IgM and high IgG but NO transaminitis

Question 6

How is hepatitis B transmitted?

Answer 6

• Sexually transmitted
• Blood products
• Mother-to-baby (e antigen is the biggest predictor)

Question 7

What is the incubation period of hepatitis B?

Answer 7

2-6 months

Question 8

What is the risk of chronic infection in adults and babies?

Answer 8

• 5-10% in adults
• 95% in babies

Question 9

Describe the molecular organisation of hepatitis B virus.

Answer 9

DNA virus with four overlapping reading frames (core, X, polymerase and surface antigen)

NOTE: as they overlap, a mutation in one reading frame could affect others

Question 10

Why do some antiretrovirals work on hepatitis B?

Answer 10

HBV uses reverse transcriptase to replicate

Question 11

Where is the hepatitis e antigen found?

Answer 11

Pre-core part of the core reading frame

It’s a marker of active replication

Question 12

What serological feature is suggestive of recent HBV infection?

Answer 12

Anti-HBV IgM antibodies

Question 13

What serological feature is suggestive of chronic HBV infection?

Answer 13

Prolonged presence of HBsAg (more than 6 months)

Question 14

What are some possible consequences of HBV infection?

Answer 14

• Hepatocellular carcinoma
• Cirrhosis

Question 15

List the HBV disease stages.

Answer 15

• Immune tolerant
• Immune reactive
• Inactive HBV carrier state
• HBeAg negative chronic HBV

Question 16

What is a strong indicator of risk of cirrhosis in people with hepatitis B infection?

Answer 16

HBV DNA level (copies/mL)

Question 17

List some treatment options for chronic HBV.

Answer 17

• Interferon alpha
• Lamivudine
• Tenofovir
• Entecavir
• Emtricitabine

Question 18

Which of these treatments should not be used in liver transplant patients?

Answer 18

Interferon alpha

Question 19

When do you NOT give Hep B immunoglobulin to babies born to mothers with Hep B

Answer 19

If the mother has anti-HBe (this confers protection to the baby, but you still give the accelerated vaccine)

Question 20

Which patient populations are particularly at risk of hepatitis C virus infection?

Answer 20

• MSM
• IVDU

Question 21

Which phylogenetic family is HCV a part of?

Answer 21

Flaviviridae

Question 22

What components constitute the viral RNA genome of hepatitis C?

Answer 22

• Core
• Envelope
• Non-structural components

Question 23

What class of drugs are most antivirals used for hepatitis C?

Answer 23

• Protease inhibitors
• Inhibitors of non-structural components

Question 24

What is the incubation period of HCV?

Answer 24

6-8 weeks

Question 25

Outline the serological changes that take place following HCV infection.

Answer 25

Anti-HCV antibodies develop after the acute infection has resolved (i.e. ALT has returned to normal)

Question 26

How is HCV treated?

Answer 26

Early treatment with peginterferon alfa

NOTE: peginterferon alfa 2b is interferon alpha with polyethelene glycol attached which improved its pharmacokinetics and turns it into a depot preparation

Question 27

How is the response to treatment with peginterferon-alfa assessed in HCV infection?

Answer 27

Sustained viral response (SVR12) - no HCV RNA 12 weeks after stopping treatment

Question 28

What is the main difference in the treatment of genotype 1 and non-genotype 1 HCV?

Answer 28

• Genotype 1 - high-dose long-lasting ribavirin is required for high cure rates
• Non-genotype 1 - ribavirin does NOT increase cure rates

Question 29

What is a key feature about hepatitis D virus?

Answer 29

Requires the presence of hepatitis B to replicate within the host

Question 30

What is the difference between hepatitis D co-infection and superinfection?

Answer 30

Co-infection:

• This happens when you are inoculated with HBV and HDV at the same time (e.g. sharing a needle with someone infected by both viruses)
• Anti-HDV IgM will rise after inoculation causing hepatitis

Superinfection:

• This happens when someone with chronic hepatitis B infection is inoculated by HDV
• This is more severe than coinfection
• Patients can develop cirrhosis within 2-3 years

Question 31

Which phylogenetic family is heaptitis E a part of?

Answer 31

Herpeviridae

Question 32

How is hepatitis E transmitted?

Answer 32

Faecal-oral

Question 33

What are the genotypes of hepatitis E?

Answer 33

• 1 + 2 = human
• 3 + 4 = animals (mainly pigs)

NOTE: there is very little person-to-person transmission

Question 34

Which patient group has a high mortality if infected by hepatitis E?

Answer 34

Pregnant women

NOTE: mainly associated with genotype 1

Question 35

What is the incubation period of hepatitis E?

Answer 35

3 - 8 weeks

Question 36

List some rare complications of hepatitis E.

Answer 36

• CNS disease (e.g. Bell’s palsy)
• Chronic infection

Question 37

Outline the treatment of hepatitis E.

Answer 37

• Supportive
• Ribavirin

Question 38

Outline the serological changes that take place in hepatitis E infection.

Answer 38

• Acute infection is accompanied by a rise in IgM anti-HEV antibody
• Rarely you can get persistently high levels of HEV RNA

NOTE: it generally responds well to ribavirin

Question 39

What is hepatitis G?

Answer 39

• Pegivirus
• Simian virus
• May cause higher CD4 counts in HIV-positive patients