VIral Hepatitis Flashcards
Types of hepatitis viruses
Hepatitis A,B,C,D and E
Most prevalent hepatitis virus in the past
Hepatitis A
Hepatitis A transmission
Faecal-oral spread
Poor hygiene, overcrowding, clusters such as gay men and PWID
Investigating hepatitis virus
Clotted blood for serology
Virus-specific Ig such as Hepatitis A IgM
Control of Hepatitis A
Hygiene, prophylactic vaccine
Most common hepatitis virus in the UK
Hepatitis E
How is hepatitis E commonly acquired in the UK
Zoonoses, often from pigs
What virus is often found with Hepatitis B and exacerbates Hepatitis B infection
Hepatitis D
Transmission of Hepatitis B
Sex - Multiple sexual partners
Mother to child - Infected mother
Blood - PWID
Born in areas of high prevalence
Investigating Hepatitis B
Blood test for Hepatitis B surface antigen (HbsAg)
Durationg of Hepatitis B antigen in blood for chronic infection
More than 6 months
What is a more sensitive predictor of prognosis and infectivity than HBeAg
Hepatitis B viral DNA
Controlling Hepatitis B
Minimise exposure, safe sex, needle exchange, screening of pregnant women
Pre-exposure vaccination
Post exposure prophylaxis: vaccine and HBIG (hyperimmune Hep B immunoglobulin)
Hepatitis C transmission
Same as hepatitis B, Sex - Multiple sexual parteners Bloods - PWID Mother to child - Infected mother Born in areas of high prevalence
What defines chronic infection
6 months or longer
Resolution in hep B vs C
Spontaneous cure not uncommon in Hepatitis B
Spontaneous cure not seen in Hepatitis C
Hep B infection in adults vs kids
Children infected at birth with Hep B are more likely to progress similarly to Hep C with chronic infection, chronic hepatitis, cirrhosis and cancer leading to death
Adults develop acute hepatitis which resolves
Follow up for positive Hep C antibody test
Test for Hep C viral RNA by PCR
Positive - Active infection
Negative - Past infection
Management of acute viral hepatitis
No antiviral given. Monitor for resolution
Notify public health
Immunise contacts and test for other infections
Vaccinate for other infections if at risk
Most common chronic viral hepatitis cause
Hepatitis C
Management of chronic viral hepatitis
Antivirals - Genotype of hepatitis virus important in deciding antiviral regime
Vaccinate - Against other hepatitis virus
If cirrhotic, vaccinate influenza and pneumococcal
Infection control
Decrease alcohol
Screen for hepatocellular carcinoma
Who to treat
Chronic infection -
HCV RNA present and genotype known
HBsAg and Hep B DNA present
Risk of complications - Evidence of inflammation
Fit for treatment - Liver cancer is contraindication, stabilise HIV first if both present
What does higher chronic HBV patients starting HBV DNA load indicate
Higher risk of cancer on follow up
What prioritized a patient for Hep B treatment
Raised inflammatory marker with advanced fibrosis and cirrhosis
