MI: Viral Hepatitis Pt.2

Question 1

What type of virus is HCV and how many genotypes are there? How is it transmitted?

Answer 1

Single-stranded RNA virus (6 genotypes)
- Sexually transmitted (MSM)
- Blood products (IVDU)

Question 2

What is the incubation period of HCV?

Answer 2

2 weeks - 6 months

Question 3

Describe the course of acute HCV infection

Answer 3

Most asymptomatic
- 30% will clear vrius
- 70% progress to chronic infection

Question 4

What is the presentation of chronic HCV?

Answer 4

• Incidental finding
• CLD/cirrhosis
• Hepatocellular carcinoma

Question 5

Diagnosis of HCV infection?

Answer 5

HCV RNA should be requested if acute infection is suspected

Anti-HCV antibodies - develop 4 weeks post infection

Question 6

How is HCV treated?

Answer 6

Direct acting antivirals for 12 weeks

• 12 week treatment course with daily pill
• Very effective against all genotypes
• Development of DAA means that HCV is now curable

Question 7

What do HCV DAAs target and give an example of a drug regimen

Answer 7

DAAs target HCV-encoded proteins responsible for viral replication

Ledipasvir PLUS sofosbuvir

Question 8

How can HCV infection be prevented?

Answer 8

No vaccine

• Screen blood, organ, and tissue products
• Needle exchange programs

Question 9

What type of virus is hepatitis D? What is a key feature about HDV?

Answer 9

Incomplete RNA virus
Requires the presence of HBV to replicate within the host

Question 10

How is HDV transmitted?

Answer 10

Same way as hepatitis B (sexual, parenteral, vertical)

Question 11

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

Answer 11

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
• Causes more severe acute disease, but low-risk chronic infection

Superinfection:

• This happens when someone with chronic HBV is inoculated by HDV
• Leads to accelarated chronic infection and patients can develop cirrhosis within 2-3 years
• This is more serious than co-infection

Question 12

How can HDV be prevented?

Answer 12

• Prevent HBV infection - vaccination, post-exposure prophylaxis
• Educate HBV patients about risky behaviours (sexual, parenteral)

Question 13

What type of virus is hepatitis E and how many genotypes?
How is it transmitted?

Answer 13

• Single-stranded RNA virus (4 genotypes)
• Faecal-oral and eating undercooked pig/boar

Question 14

In which group of people is HEV infection very dangerous and which genotype is responsible?

Answer 14

HEV genotype 1 infection in pregnant women can have a mortality of 30%

Question 15

What are the natural courses of HEV infection?

Answer 15

Most asymptomatic

• Acute infection - brief and self-limiting
• Chronic infection (ONLY IN IMMUNOCOMPROMISED) - also mild disease and can be cleared by reducing immunosuppression

Question 16

What is the incubation period of hepatitis E?

Answer 16

2 - 8 weeks

Question 17

How is HEV diagnosed? How is chronic infection classified?

Answer 17

• Immunocompetent - HEV IgM and IgG
• Immunocompromised - HEV RNA (Ab often undetectable)

Chronic infection classified as HEV RNA positive >3 months

Question 18

Outline the treatment of hepatitis E.

Answer 18

Supportive

• Severe acute hepatitis - consdier ribavirin
• Chronic hepatitis - reduce immunosuppression

Question 19

What are some extrahepatic manifestations of HEV infection?

Answer 19

Question 20

What viruses can cause chronic hepatitis?

Answer 20

B, C, D, E (only in IMMUNOCOMPROMISED)