Viral Hepatitis

Question 1

What non-hepatitis viruses can cause Hepatitis ?

Answer 1

CMV/ EBV
many others

Question 2

What is the incubation period of Hepatitis A?

Answer 2

A: 2-6 Weeks

Usually 28-30 days

Question 3

What test are done to diagnose acute Hep A infection

When do antibodies against hepatitis A generally increase?

When should it not be requestted in?

Answer 3

Might only increase in first week of symptoms

Only sent If ALT >500 sent (not under - unlikely to be positive.

Might be up to up to 14 Weeks

Question 4

What is the general treatment approach for acute hepatitis A?

Answer 4

Largely supportive care

Vaccine for prevention
Live attenuated and inactivated preparations

Question 5

How long a patients with acute hepatitis A infectious for?

Answer 5

2 weeks pre-symptom onset and
for 1 week after onset of
jaundice
* Advice for patient: stay off work for
7 days from onset symptoms

+ Notifiable disease

Question 6

What is the incubation period of the hepatitis viruses?

Answer 6

A: 2-6 Weeks
B: 2-6 months
C: 2 Weeks - 6 m onthts
E: 2-8 week s

Question 7

What is the likelihood of progression of acute hepatitis B to chronic hepatits?

Answer 7

If under 5 years: 90% (+acute infenction asymptomatic)

In adults 10% chronic hepatitis (and 20-40 sympaomtaitC)

Question 8

Recall the differnt Hepatitis B serological markers that can be measured and explain what they mean

Answer 8

Question 9

What is the surveillance of chronic Hep B infected people with cirrhosis to detect hepatocellular carcinoma?

Answer 9

AFP and liver USS every 6 months

Question 10

What is the teratment for Hep B?

Answer 10

Generally reserved for chronic Hepatitis B with aim to reduce complications –> long-term oral therapy with antivirals unti HBsAg negative (can be indefinite)

1. Peppyglafted INF alpha but low tolerability (injections for 48 weeks + loads of side-effects)
2. Antivirals (similar to HIV)
   * Lamivudine (nucleoside analogue)
   * Entecavir (nucleoside analogue)
   * Telbivudine (nucleoside analogue)
   * Tenofovir (nucleoTide analogue)

Question 11

How is vertical transmission Hepatitis B prevented ?

Answer 11

If Mother is
1. HBsAg positive, eAg-ve = low viral load accelerated couse of vaccine (Vaccine at birth + at normal intervals)
2. HBsAg positive, eAg positive , high viral load vaccine at birth and IvIg for Hep B

Question 12

What is the main route of transmission of Hepatitis C?

Answer 12

Mainly via parenteral
* needle sharing
* blood products + needle stick
(rare transmission sexually)

Question 13

What is the likelihood of progression of acute hepatitis C to chronic hepatits?

Answer 13

40-60% will progress to chronic

(many are asymptomatic)

Question 14

What is the diagnostic test for suspected acute hepatitis C infection?

Answer 14

HCV RNA (as antibodies take 4 weeks to develop)

(If RNA negative –> no acute or chornic hepatitis C infection)

((anti-HCV Ab develops after acute infection))

Question 15

What is the treatment for Hep C?

Answer 15

12 week course of antivirals
prevention of recurrent infeciton via risk behaviour

Usually a combination of 2 antivirals for 12 Weeks:

1. NS3/4 protease inhibitors (-previrs,
   block translation): telaprevir, boceprevir,
   simeprevir, asunaprevir (learn one or two)
2. NS5A inhibitors (-asvirs, block release):
   ledipasvir, daclatasvir
3. Direct polymerase inhibitors (-buvirs, block replication): Sofosbuvir, dasabuvir

Question 16

What is the clnical significance of hepatitis D infection?

Answer 16

if infected at same time: severe acute infection, but low risk of chronicity

If superinfection (D onto chornic B): high risk of complications and severe disease (cirrhosis in 2-3 years)

Question 17

What is the treatment for Hepatitis D?

Answer 17

Generally prevention of Hep B

And if already B: similar prevention (needle exchange/ sexual)

Treatment of Hep B can be more effective with
administration of Peginterferon-⍺

Question 18

What is the clinical significant of Hepatitis E

Answer 18

Can cause acute infection (and chronic only in immunosuppressed) ,

but up to 30% mortality in pregnancy with certain genotypes

Question 19

What are some of the extra-hepatic manifestations of hepatitis E?

Answer 19

Question 20

What is the treatment for Hepatitis E?

Answer 20

Largely supportive care

Vaccine - Effective in trials- recombinant HEVg1