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Slide 1: HEPATITIS B, HEPATITIS C AND HIV Jane Minton Consultant in Infectious Diseases & Tropical Medicine Leeds Teaching Hospitals Trust
Slide 2: 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?
Slide 3: HOW DO YOU GET HEPATITIS B? EXPOSURE TO BODY FLUIDS – IVDA – NEEDLESTICKS ETC. – AMATEUR BODYPIERCING ETC. – BLOOD TRANSFUSION – SEX – PERINATAL
Slide 4: WHAT ARE THE SYMPTOMS OF ACUTE HEPATITIS B? • FATIGUE AND MALAISE • NAUSEA AND VOMITING • FEVER • RUQ PAIN AND MYALGIA • JAUNDICE
Slide 5: 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
Slide 6: HOW DO YOU TREAT ACUTE HEPATITIS B ? • SYMPTOMATIC – ANALGESIA – ANTIEMETICS – ANALGESIA • SUPPORTIVE – – – – HYDRATION NUTRITION COAGULATION (TRANSPLANTATION) • EDUCATION – TRANSMISSION
Slide 7: WHAT ARE THE COMPLICATIONS OF CHRONIC HEPATITIS B? • CHRONIC LIVER DAMAGE • CIRRHOSIS • CANCER • TRANSMISSION TO OTHERS
Slide 8: CAN YOU TREAT CHRONIC HEPATITIS B? • INTERFERON • LAMIVUDINE • LIVER TRANSPLANT
Slide 9: PREVENTION OF HEPATITIS B • EDUCATION – SAFE SEX, NOT SHARING NEEDLES ETC • SCREENING – CASE CONTACTS – ANTENATAL – IVUs • VACCINES – ACTIVE (HBV sAg) – PASSIVE (HBIG) •
Slide 10: 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
Slide 11: 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
Slide 12: 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?
Slide 13: HOW DO YOU GET HEPATITIS C? • BLOOB-BORNE – IVDA – NEEDLESTICKS ETC. – AMATEUR BODYPIERCING ETC. – BLOOD TRANSFUSION • [SEX] • [VERTICAL]
Slide 14: WHAT HAPPENS WHEN YOU GET HEPATITIS C? • OFTEN ASYMPTOMATIC TO START WITH • MOST PEOPLE REMAIN INFECTED [CHRONIC HEPATITIS C]
Slide 15: WHAT ARE THE SYMPTOMS OF CHRONIC HEPATITIS C? • NOTHING • MALAISE AND FATIGUE • LIVER FAILURE – CIRRHOSIS – ASCITES – JAUNDICE – BLEEDING – ENCEPHALOPATHY
Slide 16: WHAT ARE THE COMPLICATIONS OF CHRONIC HEPATITIS C? • CHRONIC LIVER DAMAGE • CIRRHOSIS • CANCER • TRANSMISSION TO OTHERS
Slide 17: HOW DO YOU TEST FOR CHRONIC HEPATITIS C? • SEROLOGY [HCV ANTIBODIES] • LIVER FUNCTION TESTS • HCV PCR • ULTRASOUND OF LIVER • LIVER BIOPSY
Slide 18: CAN YOU TREAT CHRONIC HEPATITIS C? • INTERFERON WITH RIBAVIRIN • LIVER TRANSPLANT
Slide 19: THE PROBLEMS WITH INTERFERON • • • • LOW SUCCESS RATE SUBCUTANEOUS INJECTION LONG COURSE OF TREATMENT LOTS OF SIDE EFFECTS – ‘FLU-LIKE – BONE MARROW – DEPRESSION • THE COST
Slide 20: PREVENTION OF HEPATITIS C • EDUCATION – NOT SHARING NEEDLES ETC, SAFE SEX • SCREENING – CASE CONTACTS – IVUs • VACCINES – NONE • PROVISION OF CLEAN NEEDLES ETC.
Slide 21: 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
Slide 22: 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
Slide 23: 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?
Slide 24: HOW DO YOU GET HIV? EXPOSURE TO BODY FLUIDS – IVDA – NEEDLESTICKS ETC. – AMATEUR BODYPIERCING ETC. – BLOOD TRANSFUSION – SEX – PERINATAL
Slide 25: WHAT ARE THE SYMPTOMS OF HIV? • NON-SPECIFIC ILLNESS (SEROCONVERSION) • NOTHING • OPPORTUNISTIC INFECTIONS EG: – – – – – ORAL THRUSH RECURRENT SHINGLES PNEUMONIA (PNEUMOCYSTIS) HEADACHES (MENINGITIS) DIARRHOEA (CRYPTOSPORIDIUM)
Slide 26: 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
Slide 27: HOW DO YOU TEST FOR HIV? • SEROLOGY [HIV ANTIBODIES] • CD4 COUNT [HELPER T CELLS] • HIV PCR [VIRAL LOAD]
Slide 28: 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
Slide 29: 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
Slide 30: 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
Slide 31: MS HI • Examination: oral thrush • Investigations • HIV antibody positive • CD4+ count 21 (normal 500+) • HIV viral load > 100,000 virus per ml blood • Treatment • 3 antiviral drugs & septrin • Support • Counselling/testing for partner