MI: Viral Hepatitis Pt.1

Question 1

Name some primary and secondary hepatotropic viruses?

Answer 1

Primary - hepatitis A, B, C, D, E
Secondary - EBV, CMV, HIV, parovirus B19

Question 2

What type of virus is hepatitis A?How is hepatitis A spread?

Answer 2

Single-stranded RNA virus

Faecal-oral
- Person-to-person (sex)
- Contaminated food/drink

Question 3

What is the incubation period for hepatitis A?

Answer 3

2-6 weeks (usually 4 weeks)

Question 4

What are symptoms of hepatitis A infection?

Answer 4

Symptoms of acute hepatitis

• Non-specific - fever, fatigue, abdominal pain, malaise, loss of appetite
• Elevated bilirubin - jaundice, pale stools + dark urine, pruritius

Question 5

Describe the natural history of hepatitis A infection.

Answer 5

• 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 6

What is the diagnostic test for acute hepatitis A?

Answer 6

Anti-hepatitis A IgM (anti-HAV IgM)

• Only request if symptomatic patient has if ALT >500u/L)
• If <500 may get false negative because antibody titres have not risen enough

may be negative in 1st week

Question 7

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

Answer 7

Anti-HAV IgG
(if infected, they will have high IgM and IgG, but no transaminitis)

Question 8

When are those with hepatitis A infectious?

Answer 8

2 weeks before until 1 week after onset of jaundice

Question 9

How is HAV treated?

Answer 9

Supportive, no chronicity

Question 10

What type of virus is hepatitis B?How is hepatitis B transmitted?

Answer 10

DNA virus

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

Question 11

What is the incubation period of hepatitis B?

Answer 11

2-6 months

Question 12

What are 3 possible courses of hepatitis B infection in adults?

Answer 12

• Clearance (90%)
• Chronic infection (10%)
• Fulminant liver failure (0.5-1%)

40% are symptomatic

Question 13

What is the course of HBV infection in children under 5 ?

Answer 13

Asymptomatic, 90% develop chronic infection

Question 14

What the biochemical definition of chronic HBV infection?

Answer 14

HBsAg positive > 6 months

Question 15

What do the presence of the following antigen/antibodies indicate:
- HBsAg
- HBeAg
- Anti-HBc IgM
- Anti-HBc IgG
- Anti-HBe IgG
- Anti-HBs IgG

Answer 15

Question 16

What are some possible consequences of chronic HBV infection?

Answer 16

• Hepatocellular carcinoma
• Cirrhosis

Question 17

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

Answer 17

HBV DNA level (copies/mL)

Scored with Child-Pugh score, diagnosed fibroscan

Question 18

List some treatment options for chronic HBV.

Answer 18

Pegylated IFN-a - aim is to induce long term immune control

• 48 weeks
• Low tolerability, lots of contraindications

Nucleoside analogues - aim is to inhibit viral replication

• Tenofovir
• Entecavir
• Lamivudine
• Adefovir

Question 19

What is the mechanism of action of nucleoside analogues?

Answer 19

Inhibit viral reverse transcriptase

Question 20

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

Answer 20

Interferon alpha

Question 21

What is the management of babies born to mothers with chronic HBV?

Answer 21

Depends on HBeAg status

• HBsAg positive, HBeAg negative - give vaccine at birth
• HBsAg positive, HBeAg positive - give vaccine at birth PLUS HBIG

Give HBIG also if HBV DNA >1 x 10^6 IU/ml