HEPATITIS B, HEPATITIS C AND HIV

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HEPATITIS B, HEPATITIS C AND HIV

• Jane Minton
• Consultant in Infectious Diseases Tropical
  Medicine
• Leeds Teaching Hospitals Trust

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HEPATITIS B

• HOW DO YOU GET IT?
• WHAT ARE THE SYMPTOMS?
• HOW DO YOU MAKE THE DIAGNOSIS?
• CAN IT BE TREATED?
• HOW CAN IT BE PREVENTED?

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HOW DO YOU GET HEPATITIS B?

• EXPOSURE TO BODY FLUIDS
• IVDA
• NEEDLESTICKS ETC.
• AMATEUR BODYPIERCING ETC.
• BLOOD TRANSFUSION
• SEX
• PERINATAL

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WHAT ARE THE SYMPTOMS OF ACUTE HEPATITIS B?

• FATIGUE AND MALAISE
• NAUSEA AND VOMITING
• FEVER
• RUQ PAIN AND MYALGIA
• JAUNDICE

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HOW DO YOU TEST FOR ACUTE HEPATITIS B?

• LIVER FUNCTION TESTS
• transaminases in 1000s
• deranged blood coagulation
• SEROLOGY
• HBV Core IgM
• HBV surface antigen
• HBV e antigen

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HOW DO YOU TREAT ACUTE HEPATITIS B ?

• SYMPTOMATIC
• ANALGESIA
• ANTIEMETICS
• ANALGESIA
• SUPPORTIVE
• HYDRATION
• NUTRITION
• COAGULATION
• (TRANSPLANTATION)
• EDUCATION
• TRANSMISSION

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WHAT ARE THE COMPLICATIONS OF CHRONIC HEPATITIS B?

• CHRONIC LIVER DAMAGE
• CIRRHOSIS
• CANCER
• TRANSMISSION TO OTHERS

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CAN YOU TREAT CHRONIC HEPATITIS B?

• INTERFERON
• LAMIVUDINE
• LIVER TRANSPLANT

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PREVENTION OF HEPATITIS B

• EDUCATION
• SAFE SEX, NOT SHARING NEEDLES ETC
• SCREENING
• CASE CONTACTS
• ANTENATAL
• IVUs
• VACCINES
• ACTIVE (HBV sAg)
• PASSIVE (HBIG)
• PROVISION OF CLEAN NEEDLES ETC.

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Case History Mr HB age 42

• Unwell for 10 days malaise, nausea, vomiting,
  abdo pain, dark urine jaundice
• Previously fit, no medication
• Recently separated, has 2 sons age 8 10
• Girl friend for 4 months, pregnant
• Fireman
• Travel to Majorca last year
• Alcohol 10U/week, non smoker no other
  recreational drug use

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Mr HB

• Examination deeply jaundiced, enlarged tender
  liver
• Investigations
• LFTs - acute hepatitis
• Serology - acute hepatitis B
• Treatment
• symptomatic
• follow-up
• Public health issues
• notifiable
• screening /- investigation of contacts
• vaccination of non-immune contacts

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HEPATITIS C

• HOW DO YOU GET IT?
• WHAT ARE THE SYMPTOMS?
• HOW DO YOU MAKE THE DIAGNOSIS?
• CAN IT BE TREATED?
• HOW CAN IT BE PREVENTED?

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HOW DO YOU GET HEPATITIS C?

• BLOOB-BORNE
• IVDA
• NEEDLESTICKS ETC.
• AMATEUR BODYPIERCING ETC.
• BLOOD TRANSFUSION
• SEX
• VERTICAL

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WHAT HAPPENS WHEN YOU GET HEPATITIS C?

• OFTEN ASYMPTOMATIC TO START WITH
• MOST PEOPLE REMAIN INFECTED
• CHRONIC HEPATITIS C

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WHAT ARE THE SYMPTOMS OF CHRONIC HEPATITIS C?

• NOTHING
• MALAISE AND FATIGUE
• LIVER FAILURE
• CIRRHOSIS
• ASCITES
• JAUNDICE
• BLEEDING
• ENCEPHALOPATHY

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WHAT ARE THE COMPLICATIONS OF CHRONIC HEPATITIS C?

• CHRONIC LIVER DAMAGE
• CIRRHOSIS
• CANCER
• TRANSMISSION TO OTHERS

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HOW DO YOU TEST FOR CHRONIC HEPATITIS C?

• SEROLOGY HCV ANTIBODIES
• LIVER FUNCTION TESTS
• HCV PCR
• ULTRASOUND OF LIVER
• LIVER BIOPSY

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CAN YOU TREAT CHRONIC HEPATITIS C?

• INTERFERON WITH RIBAVIRIN
• LIVER TRANSPLANT

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THE PROBLEMS WITH INTERFERON

• LOW SUCCESS RATE
• SUBCUTANEOUS INJECTION
• LONG COURSE OF TREATMENT
• LOTS OF SIDE EFFECTS
• FLU-LIKE
• BONE MARROW
• DEPRESSION
• THE COST

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PREVENTION OF HEPATITIS C

• EDUCATION
• NOT SHARING NEEDLES ETC, SAFE SEX
• SCREENING
• CASE CONTACTS
• IVUs
• VACCINES
• NONE
• PROVISION OF CLEAN NEEDLES ETC.

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CASE HISTORY MR HC AGE 33

• Registers with GP asking for detox.
• Complains of tiredness first thing in morning
• PMH jaundice age 26
• 10 year history IVU, has shared equipment in the
  past
• Lives with partner (also IVU) who is pregnant
• Alcohol rarely, smokes 15/day
• No foreign travel

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MR HC

• Examination normal except needle tracks
• Investigations
• HCV Ab positive HBV past infection, HIV
  negative
• LFTs ALT 121
• HCV PCR positive
• ultrasound of liver normal
• liver biopsy moderate hepatitis
• Treatment
• candidate for interferon plus ribavirin (NB drug
  use)
• Public health issues
• notifiable
• screening /- investigation of contacts

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HIV

• HOW DO YOU GET IT?
• WHAT ARE THE SYMPTOMS?
• HOW DO YOU MAKE THE DIAGNOSIS?
• HOW DO YOU TREAT IT?
• HOW CAN IT BE PREVENTED?

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HOW DO YOU GET HIV?

• EXPOSURE TO BODY FLUIDS
• IVDA
• NEEDLESTICKS ETC.
• AMATEUR BODYPIERCING ETC.
• BLOOD TRANSFUSION
• SEX
• PERINATAL

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WHAT ARE THE SYMPTOMS OF HIV?

• NON-SPECIFIC ILLNESS (SEROCONVERSION)
• NOTHING
• OPPORTUNISTIC INFECTIONS EG
• ORAL THRUSH
• RECURRENT SHINGLES
• PNEUMONIA (PNEUMOCYSTIS)
• HEADACHES (MENINGITIS)
• DIARRHOEA (CRYPTOSPORIDIUM)

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WHAT DOES HIV DO?

• INFECTS AND DESTROYS KEY CELLS IN IMMUNE SYSTEM
• ESPECIALLY CD4 OR HELPER T CELLS
• MAY INFECT OTHER TISSUES EG NERVE CELLS
• MAKES PATIENTS MORE SUSCEPTIBLE TO INFECTIONS
• COMMON INFECTIONS
• OPPORTUNISTIC INFECTIONS

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HOW DO YOU TEST FOR HIV?

• SEROLOGY HIV ANTIBODIES
• CD4 COUNT HELPER T CELLS
• HIV PCR VIRAL LOAD

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HOW DO YOU TREAT HIV?

• COMBINATION ANTIRETROVIRAL DRUGS
• AT LEAST 3
• MAJOR CLASSES
• REVERSE TRANSCRIPTASE INHIBITORS
• NON-NUCLEOTIDE RTIs
• PROTEASE INHIBITORS
• PROPHYLACTIC DRUGS EG FOR PCP
• EDUCATION
• NUTRITION
• SUPPORT

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PREVENTION OF HIV

• EDUCATION
• SAFE SEX, NOT SHARING NEEDLES ETC
• SCREENING
• CASE CONTACTS, ANTENATAL, IVUs
• PROVISION OF CLEAN NEEDLES ETC
• POST-EXPOSURE PROPHYLAXIS
• NO VACCINES

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CASE HISTORY MS HI AGE 26

• Premature delivery at 28 weeks
• PMH anaemia UTIs in pregnancy
• Drugs iron
• Student from Zimbabwe in UK for 6 months
• 1 child from previous marriage
• Current partner well
• Alcohol 2u/week, non-smoker, no recreational drug
  use
• Baby HIV antibody positive

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MS HI

• Examination oral thrush
• Investigations
• HIV antibody positive
• CD4 count 21 (normal 500)
• HIV viral load gt 100,000 virus per ml blood
• Treatment
• 3 antiviral drugs septrin
• Support
• Counselling/testing for partner