Viral hepatitis Flashcards
How many types of hepatitis are there and what are their names?
5 Hepatitis A Hepatitis B Hepatitis C Hepatitis D Hepatitis E
How is Hepatitis A spread?
Faecal to Oral spread
Poor Hygiene/Overcrowding
No carrier state
Can be present in urine
Is Hepatitis A chronic or acute?
Acute
What group of people have peak incidence of symptomatic disease?
Older children/Young Adults
How is Hep A diagnosed?
Clotted blood for serology
(Gold top vacutainer)
Hepatitis A IgM
How is Hep A controlled?
Hygiene
Vancine Prophylaxis
Where is Hep E most common?
Tropics
What is Hep E’s transmission route?
Faecal-oral
What are Hep E cases in the UK classified as?
Zoonoses
Is there a Hep E vaccine?
No :(
Can patients get chronic infection from Hep E?
Only those who are immunosuppressed
What other Hep is Hep D always found with?
Hep B
Is Hepatitis D parasitic?
Yeas
What does Hep D do to a Hep B infection?
Exacerbates it
How is hep B transmitted?
Sexually
Mother to child
Blood
Who is at high risk of Hepatitis B?
People born in areas of intermediate/high prevalence
Multiple sexual partners
People who inject drugs
Children of infected mothers
How is Hep B confirmed?
HBsAg is present in the blood of all infectious hep b individuls
When is HBsAg present in chronic Hep B infections?
For more than 6 months
What are Hep B DNA tests also used to predict the risk of?
Chronic liver disease
When is Hep B IgM most likely to be present?
Recently infected cases
When are Anti-Hb’s present?
In immunity cases
How can Hep B be controlled?
Minimising exposure Safe blood Safe sex Needle exchange Prevention of needlestick injury Screening of pregnant women
Is there a Hep B Vaccine?
Yes,
Two actually
One for all children
One for at risk children and adults
Is there such think as post exposure prophylaxis in Hep B cases?
Yes
Vaccine
HBIG (Hyperimmune Hep B immunoglobin)
Is there a vaccine for hepatitis C?
No :(
How often does a Hep C virus result in a chronic infection?
75% of cases
How many months of infection means chronic?
6 months
Can Hep B be spontaneously cured?
Yes
Can Hep C be spontaneously cured?
No
What is the typical time period from infection to cirrhosis?
> 20 years
What is the typical time period from infection to hepatocellular carcinoma?
> 30 years
What is more common Heb B or Hep C?
B
What is the management of acute viral hepatitis?
NO Antivirals Monitor for encephalopathy Mintor for resolution Notify Public Health (Ellie Hothersall bae) Immunisation of contacts Test for other infections Vaccinate against other infections
What is the management of chronic viral hepatitis?
ANTIVIRALS: -Adefovir -Entecavir -Tenofovir etc VACCINATIONS -Other hepatitis viruses -If cirrhotic: Influenza, pneumococcal Infection control Decreasing alcohol Heapatocellular carcinoma screening
What must we consider when deciding who to treat with Antivirals?
Chronic infections Risks of complications : evidence of inflammation Fibrosis Fitness for treatment Patient's priorities
What should we consider when deciding when to treat a patient?
Before the complications
When evidence of inflammation is present
When the patient is ready
What is Interferon alfa?
A human protein that is part of the immune response to viral infection
It can be made by drug companies
In the form of peginterferon
What are adverse side effects of peginterferon?
Flu like symptoms Chills sore muscles Malaise Thyroid disease Autoimmune disease Psychiatric disease
What is an adverse effect of Ribavirin?
Anaemia
When should peginterferon be used over entecavir?
In HBsAg and HBeAg pos patients with compensated disease and prediction of good chance of cure
What are the benefits of chronic hepatitis B therapy?
Virological reduction in HBV DNA (suppression) loss of HBeAg (more enduring suppression) loss of HBsAg (cure) Improved liver biochemistry Improved histopathology Reduced infectivity Reduced progression to cirrhosis and primary hepatocellular carcinoma Reduced mortality
What are the benefits of chronic hepatitis C therapy?
Response defined by loss of HCV RNA in blood sustained to 6 months after end of therapy
virological cure
known as Sustained Virological Response or SVR
relapse after SVR is rare
reinfection can occur
After SVR patients have:
improved liver biochemistry
improved histopathology
reduced infectivity
reduced incidence of primary liver cancer
reduced mortality
What are the principles of HCV therapy?
Choice of antiviral regime based on:
Genotype of virus, and viral load
Genotype of patient’s interferon response genes
This is less important as interferon used less
Stage of disease
Past treatment experience, genotypic resistance info
Likelihood of side-effects, inc Drug Drug Interactions
Cost effectiveness considerations
Responses of >90% SVR are now considered benchmark to aim for
