Viral Hepatitis

Question 1

How is `Hep A spread and what is its incubation period

Answer 1

Faecal oral

2-6 weeks

Question 2

Diagnostic test of Hep A

Answer 2

anti-HAV IgM

Acute infection- IgM reactive, unlikely if bilirubin is below 30

Past infection- IgM non reactive, IgG reactive

Question 3

Route of Transmission of HBV

Answer 3

o Sexually transmitted
o Blood products
o Mother-to-Baby (vertical)

Question 4

Chances of HBV causing a chronic infection

Answer 4

o Adults have a 5-10% chance of developing chronic infection
o Babies have a 95% chance of developing chronic infection
o Incubation period: 2-6 months

Question 5

Serology of HBV

Answer 5

Acute infection- HBsAg, antiHbc Igm
Chronic infection, HBsAg, antiHbc IgG
Vaccinated- AntiHbS
Past infection- AntiHbS, antiHbc IgG

Question 6

Consequences of HBV infection

Answer 6

o Hepatic fibrosis  cirrhosis  HCC
o Most common cancer associated = Hepatocellular carcinoma (HCC)
o It tends to occur in diseased livers

Question 7

Chronic HBV Treatment

Answer 7

o Interferon Alpha (used in a subset of patients who look like they are clearing the virus by themselves)
Do not use in patients who may require a liver transplant
o Lamivudine
o Tenofovir
o Entecavir
o Emtricitabine

Question 8

Treatment to baby in a HBV positive mother

Answer 8

Hep Vaccine and HBIG

Question 9

Test for hepatocellular carcinoma

Answer 9

AFP levels

Question 10

HDV infection types

Answer 10

HBC/HDV co-infection- similar to acute HBV, self limitng

If HBV infected and inoculated by HDV- superinfection- more severe can develop cirrhosis in 2-3 weeks

Question 11

Chances of chronic infection in HCV

Answer 11

60%

Question 12

HCV serology

Answer 12

HCV RNA is the best way to check whether you have the virus in your blood

Anti-HCV develop after acute infection

Question 13

Treatment of HCV

Answer 13

• Early treatment with interferon has a HIGH success rate

• NEW HCV drugs / Direct Acting Antivirals (DAAs) cures the majority (94%) of patients
o NS3/4 serine protease
o NS5a RNA
o NS5b RNA dependent RNA polymerase

Question 14

How is HEV spread

Answer 14

o Faecal-oral route (remember, fAEcal-oral)
 It is also a zoonosis – It can be transmitted from animals to humans (mainly pigs)
 Shellfish consumption, blood transfusion, sausages, pig liver consumption

Question 15

Complications of HEV

Answer 15

o CNS Disease (Bell’s palsy, Guillain-Barre)
o Chronic infection
o Very dangerous to pregnant women (esp. in the third trimester)

Question 16

Treatment of HEV

Answer 16

o Supportive Vaccine- Effective but not necessary in the UK
o Ribavirin

Question 17

Serology of HEV

Answer 17

o The acute infection is accompanied by a rise in IgM anti-HEV antibody
 HEV RNA detectable in serum and stool in incubation period