Viral Hepatitis Flashcards
Types of Hep viruses and how common are they in the UK?
A - less common now due to vaccination for travellers and better housing
B - mostly in ethnic minorities, who may be chronic carriers of infection
C
D - rare
E - rising
Table of hepatitis types?
ADD TABLE
Clinical course of hep B infection?
Immune tolerance phase 1 Immune clearance phase 2 Immune control phase 3 Immune escape phase 4
Describe the general clinical course of Hep B infection
Patient’s relationship with infection is dynamic; people will move between stages
Potential steps in Hep A infection?
Potential steps in Hep B infection, if infected as an adult?
Potential steps in Hep C infection?
Management of acute viral hepatitis?
Symptomatic; no anti-virals are given
Monitoring in acute viral hepatitis?
Monitor for encephalopathy and resolution
Test for other infection, as they are at risk, and vaccinate against other infections, if they are at risk
Management of chronic viral hepatitis?
Anti-virals (there are six for HBV and eight for HCV)
Vaccination for other Hep viruses and, if cirrhotic, vaccinate against influenza and pneumococcal
Decrease alcohol intake
Infection control
Hepatocellular carcinoma awareness/screening
Which people are treated with anti-virals in hepatitis, e.g: adefovir and entecavir?
Chronic infection:
HCV RNA present and genotype known
HBsAg and Hep B DNA present
Risk of complications:
Evidence of inflammation / fibrosis sought
Non-invasive tests for fibrosis e.g. fibroscan or biopsy
Biochemical evidence of inflammation (↑ALT)
Fit for treatment:
Established cirrhosis more difficult to treat
Liver cancer is a contraindication
HIV co-infection more difficult to treat
Patient issues:
Consider risk of serious side effects of antivirals attitude to treatment, and lifestyle issues
How is HBV DNA load related to hepatocellular carcinoma?
Higher a chronic HBV patient’s starting HBV DNA load, the greater the risk of cancer on follow-up
What is interferon alfa?
A human protein that is part of the immune response to viral infection
It can be administered by infecting pegylated interferon (peginterferon), which has a complex mode of action but inc. action as an immune adjuvant
Common and severe side effects of peginterferon?
Common - flu-like illness with rigors, myalgia and malaise
Severe - thyroid disease, autoimmune disease (e.g: SLE), psychiatric disease (avoid in those with a PMH of depression)
2 options for hep B therapy?
Option 1 - peginterferon alone; try in HBsAg and HBeAg positive patients with compensated disease and a prediction of good chance of cure
Option 2 (more common) - suppressive anti-viral drug
Advantages and disadvantages of option 1?
Advantages: Sustained cure possible from a few months of therapy
Disadvantages:
Side effects injections
Only a minority gain benefit
Advantages and disadvantages of option 2?
Advantage:
Safer
Increasing range available
Disadvantage:
Suppression, not cure
Resistance can develop
Examples of Hep B anti-virals?
Entecavir
Tenofivir
What is the aim, in terms of sustained virological response, in HCV therapy?
Responses of >90% SVR (sustained virological response) are now considered benchmark to aim for
Which anti-virals, for Hep C, can be used for all genotypes?
Peginterferon alfa and ribavirin but these have serious side effects
Use of telaprevir and boceprevir?
Only for genotype 1 and enhances peginterferon/ribavirin
Serious side effects
What are the newer anti-virals and when are they used?
Simeprevir, Ledipasvir, Daclatasvir are used in certain genotypes in combination with other drugs; they are safe and well tolerated
Sofosbuvir can be used against all genotypes and is used in combination; it is safe and well tolerated
