Viral Hepatitis Flashcards
How is Hep A transmitted?
Fecal-Oral, contaminated food/water
Symptoms of HepA
Abdominal Pain, Jaundice, pale stools, dark urine, loss of appetite
Is hepA acute or chronic?
Acute: usually lasts less than 2 months
Can hepA be transmitted via sex or drug use?
Yes, of course!
What are risk factors for getting hepA?
A. Travel to or living in an area with poor sanitation or lacking safe water
B. Men who have sex with men
C. Recreational drug use
D. Direct contact with an infected person
1. Living in same home
2. Sexual partner
E. Clotting factor disorders
F. Working with non-human primates
G. Most outbreaks have been due to homelessness and illicit drug use
What is the significance of Anti-HAV IgG vs IgM?
IgM is only elevated during infection and is diagnostic of a current or recent infection. IgG can stay elevated for decades.
What are the 4 phases of HepA infection?
Phase 1: viral replication
D. Phase 2: prodromal phase (anorexia occurs here)
E. Phase 3: icteric phase (dark urine, pale stools, upper GI pain)
F. Phase 4: convalescent phase (symptoms usually resolve, liver enzymes end up returning back to normal)
Management of HepA?
Self-limiting. Avoid APAP. Fluid replacement is the most important.
Who should get HepA vaccine, and what is the schedule?
Anyone over 1 year of age, or at risk.
2 doses at least 6 months apart.
Who gets hepA immune globulin?
Someone exposed but not vaccinated.
What HepA vaccines are there, and what are the differences?
All are inactivated. Neomycin allergy is a problem. Can give during preg. If second dose is delayed, series does not need to start over.
Havrix: Hep-A only. 0.5 ml for 1-18yo, 1 ml for adults. 2 doses 6-12 months apart
Vaqta: Hep-A only. Same dosing as Havrix. 2 doses 6-18 months apart.
Twinrix: Both Hep-A and Hep-B. For adults. Two schedules:
3-dose: 0, 1, 6 months
4-dose: 0,7,21-30 days, then HepB booster at 12mo.
What about pre-exposure prophy for HepA for peds < 1 year? (If traveling to high risk area)
If the kid is under 6 mo:
May give HepA immune globulin 0.1 ml/kg for 1 month, 0.2 for 2 months travel, or 0.2 ml/kg every 2 months for longer travel durations.
If the kid is 6-12 mo: Just give the vaccine, but this does not count towards the series.
What about adults needing hepA prophy for travel? (For non-immune travelers)
For pts 1-40 yo, give a dose of the vaccine ASAP, and finish the series on schedule.
For pts > 40 yo, or immune compromised, or chronic liver dx: Give vaccine + 0.1-0.2 ml/kg immune globulin (same dosing as peds < 6 mo)
What about post-exposure prophy for hepA (for non-immune individuals).
Give within 2 weeks of exposure.
Similar to pre-exposure scheme. If you can give the vaccine, do that. Otherwise give the immuneglobulin. E.g. kids under 6 mo and adults over 40 or immune compromised or liver dx, give immune globulin.
Is hepB acute or chronic?
Chronic!
How is HepB transmitted?
Blood or body fluids
What does the HepB acute infection look like?
Looks similar to HepA. Often asymptomatic. Treat with supportive measures only.
What does the HepB chronic infection look like?
A. Commonly asymptomatic B. Ascites C. Encephalopathy D. Extrahepatic manifestations 1. Polyarteritis nodosa 2. Glomerular disease E. Jaundice F. Peripheral edema G. Splenomegaly H. Transaminitis
Requires the use of antivirals to treat.
Risk factors for HepB infection?
A. Direct contact with an infected person
1. Living in same home
2. Sexual partner
B. Mother-to-child transmission during child birth
C. MSM
D. Occupational exposure to blood or blood-contaminated body fluids
E. Hemodialysis
Consequences of untreated Hepatitis?
Cirrhosis, Hepatocellular carcinoma, 5-year survival with compensated cirrhosis is around 85%, while for decompensated (ascites or bleed varices) it is around 14-35%
How to assess prognosis of liver disease and estimate cirrhosis severity?
Child-Turcotte-Pugh (CTP) Score Assigned class A B or C depending on points (5-6, 7-9, 10-15). Based on ascites, hepatic encephalopathy, INR, Serum albumin, and total bilirubin.
What are the different tests for HepB?
Hepatitis B Surface Antigen (HBsAg) Assists in diagnosing acute/chronic active infection. Patient is infectious
Hepatitis B Surface Antibody (HBsAb or anti-HBs) Assesses immunity and recovery from infection
Hepatitis B Core Antibody (Total) (HBcAb or Total anti-HBc) Appears at onset of infection and remains for life
Hepatitis B Core Antibody (IgM) (IgM anti-HBc) Indicates acute infection
Hepatitis B Envelope Antigen (HBeAg)
Indicates active viral replication. Patient is infectious
Hepatitis B Envelope Antibody (HBeAb or anti-HBe)
No replication occurring
Hepatitis B Virus DNA (HBV DNA) How rapidly the virus is reproducing in the liver
When to treat hepB?
AASLD: HBV DNA > 20,000 and ALT > 2x ULN OR Cirrhosis
EASL: Similar but adds that with HBV DNA > 2,000 with any ALT elevation and/or moderate inflammation or fibrosis you can also treat (like everything is medium at the same time)
Which two antiretrovirals share the same resistance pattern and what is the significance of that?
Lamivudine and Emtricitabine:
-If resistance to one, don’t use the other.
Which Hep B treatments are preferred for elderly patients or those with preexisting bone or renal disease.
Entecavir or TAF
Hep B therapy of choice for pregnant patients?
TDF
How young can should you start HepB vaccination?
“b” is for Birth!
