Hepatitis

Hep A:  transmitted via fecal-oral, person-person, contaminated food or water

  • Usually self-limiting at which time life-long immunity is conferred
  • Cytolytic T-cell mediated response
  • Kids can be asymptomatic

Hep B:  transmitted via blood, saliva, urine, vag fluids, semen, perinatal transmission

  • Leading cause of chronic hepatitis (10% of adults w/ acute hepatitis will develop chronic disease), cirrhosis & hepatocellular carcinoma
  • Acute symptoms resolve w/o treatment
  • HBeAg antibody correlates with a high degree of infectivity

Hep C:  transmitted via needles, sex, etc

  • Most patients are asymptomatic until cirrhosis develops

Common diagnostic tests utilized in and manifestations of infectious hepatitis (IH)

  • Hep B:
    • Positive HBsAg for > 6 months with elevated AST/ALT enzymes   – or –   Positive HBeAg with measurable HBV DNA in serum
  • Hep C:  ELISA immunoassay
    • However routine screening for high-risk ppl isn’t recommended
    • Treat if patient has (+) HCV antibodies for > 6months, (+) HCV RNA, elevated serum aminotransferase levels, histological evidence of inflammation

Risk factors for acquiring IH

  • Sexually active, use cocaine, tattoos, body piercings, contaminated needles, healthcare workers exposed to blood products, hemodialysis, blood transfusions before 1992

Treatment options for infectious hepatitis (IG)

  • Interferon
    • Inhibits viral replication & stimulates the immune system to clear infected cells
    • PEG-interferon Alpha-2a (pegasys)
    • Alpha-2b (intron A) is the only interferon indicated for the treatment of HBV
  • Lamivudine
    • Inhibits DNA polymerase
    • Unlike Interferon, it can be used in decompensated liver disease
  • Adefovir (Hepsera)
    • Prodrug that inhibits HBV reverse transcriptase
    • Used for chronic HBV w/ active viral replication and that has been proven to be an active disease via histology
    • Can be used for patient resistant to lamuvidine
    • If used for Hep B & the MD didn’t know the patient had HIV, the HIV strand may become resistant to this drug’s use
  • Entecavir (baraclude)
    • Used for chronic HBV
    • Effective if disease is resistant to lamivudine
  • Hep C:
    • Interferons
      • Alfa-2a (roferon-A)
      • Alfa-2b (Intron A)
      • Alfacon-1 (infergen)
    • Peginterferons
      • Alfa-2a (pegasys)
      • Alfa-2b (PegIntron)
    • Ribavirin (used in combo w/ interferon alpha)–aka rabetol, rebetron, copegus

Summary:

  • Lamivudine:  used for HBV
  • Interferons
    • Alfa-2a (Roferon-A):  used for HCV
    • Alfa-2b (Intron A):  used for both HBV & HCV
    • Alfacon-1 (Infergen):  used for HCV
  • Peginterferons
    • Alfa-2a (Pegasys):  used for both HBV & HCV
    • Alfa-2b (PegIntron):  Used for HCV
  • Ribavirin:  used for HCV
  • Adefovir:  used for HBV

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