Viral Hepatitis

Question 1

Viral Hepatitits: What is it?

Answer 1

Hepatitis= inflammation of the liver.
Viral Hepatitis= inflammation of the liver due to viral infection

Question 2

HepA

Answer 2

• RNA Virus
• Faecal-Oral Route: contaminated food or water
• Diagnosed with IgM antibodies
• Managed with support and analgesia
  It usually resolves without treatment.
• only serious in immunocompromised and pregnant

Question 3

HepB

Answer 3

• double-strandedDNA virus
• transmitted via placenta and bodily fluids. Eg. Sexual intercourse, needles (tattoos, IV drug users), toothbrushes.
• Screening for hepatitis B involves testing forHBcAb(for previous or current infection) andHBsAg(for active infection). When these are positive, further testing is performed forHBeAgandviral load(HBV DNA).

There are key viral markers to remember with hepatitis B:
- - Surface antibody(HBsAb) – implies an immune response by vaccination or past or current infection. negative in chronic disease.
- - Core antibodies(HBcAb) – implies an immune response by past (in the last 6 months) or current infection. We measure IgMandIgGversions of the HBcAb to distinguish between past, acute and chronic infections.IgGindicates apast infectionwhere the HBsAg is negative; IgMimplies anactive infectionand will give ahigh titrewith anacute infectionand alow titrewith achronic infection.
- Surface antigen(HBsAg) – active infection/carrier
- E antigen(HBeAg)– a marker of viral replication and implies high infectivity. Negative HBeAg but positive HBeAb implies latent viral replication
- Hepatitis B virus DNA(HBV DNA) – a direct count of the viral load

Management:
- - Referral to gastroenterology, hepatology or infectious diseases for specialist management
- Antiviral medication can be used to slow the progression of the disease and reduce infectivity
- Liver transplantation for liver failure (fulminant hepatitis)
- Avoid alcohol
- Education about reducing transmission
- Contact tracing and informing potential at-risk contacts
- A low threshold for screening patients at risk of hepatitis B

• Screen for other viral infections (e.g., HIV, hepatitis A, C and D)
• Testing for complications (e.g., FibroScan for cirrhosis and ultrasound for hepatocellular carcinoma)

Most people fully recover from the infection within 1-3 months. However, 5-15% becomechronic hepatitis B carriers.

Question 4

HepC

Answer 4

• RNA Virus
• transmitted via bodily fluids. Eg. Sexual intercourse, needles (tattoos, IV drug users), toothbrushes.
• investigations: HCAb and HCV RNA to confirm the diagnosis of hepatitis C, calculate theviral loadand identify thegenotype for tailored treatment with direct-acting antivirals(DAAs)

Management
- Referral to gastroenterology, hepatology or infectious diseases for specialist management
- Direct-acting antiviral (DAAs) (eg. lamivudine) medication to cure in 8 to 12 weeks.
- Liver transplantation for liver failure (fulminant hepatitis)
- Avoid alcohol
- Education about reducing transmission
- Contact tracing and informing potential at-risk contacts
- A low threshold for screening patients at risk of hepatitis B

• Screen for other viral infections (e.g., HIV, hepatitis A, C and D)
• Testing for complications (e.g., FibroScan for cirrhosis and ultrasound for hepatocellular carcinoma)

Question 5

HepD

Answer 5

• RNA Virus
• A complication of HepB as attaches to HBsAg. Increases severity and complications of HepB
• Management: pegylated interferon alphaover at least 48 weeks. This treatment is not very effective and has significant side effects.

Question 6

HepE

Answer 6

• RNA virus
• faecal-oralroute (usually pig meat)
• only a mild illness, the virus is cleared within a month, and no treatment is required. Rarely it can progress to chronic hepatitis and liver failure, usually in immunocompromised patients.

Question 7

Hepatitis: Complications

Answer 7

• chronic hepatitis
• cirhosis - (in chronic hepatitis)
• liver failure (jaundice and confusion)

Question 8

Hep B and pregnancy

Answer 8

• screen all pregnant women
• babies born to mothers with hep B acute or chronic (HBsAg positive) - complete course of vaccination + hepB IG 0.5mm within 12 hours of birth
• HepB vaccine at birth + 1-2months + 6months
• no HepC vaccine