Viral Hepatitis Tutorial
Transcript of Viral Hepatitis Tutorial
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Viral HepatitisTutorialTutorial
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FEATURE A B C D E G TTV
Family Piconavi
ridae
ssRNA+
Hepadna
viridae
dsDNA
Flaviviri
dae
ssRNA+
Unclssifi
ed
ssRNA-
Hepeviri
dae
ssRNA+
Flaviviri
dae
ssRNA+
Anellovi
ridae
ssDNA-
Genus Hepato
virus
Orthohe
padnavirus
Hepaci
virus
Deltavirus Hepevirus Tentative
Hepaci
virus
Anello
virus
Mean IP (days) 20-30 60-90 60-90 60-90 20-30 ? ?
Hepatitis Viruses
Typical onset Sudden Slow Slow Variable Sudden ? ?
Age preference Child –
young
adult
All All All All ? ?
Severity Usually
mild
Modera
te
Can be
severe
Severe
in
HBV+
Usually
mild
? ?
Acute Fulminat
hepatitis
<0.5% <1-2% 0.5-1% high 1-2% ? ?
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FEATURE A B C D E G TTV
Chronicity None Low-Mod High Mod-high None Likely Likely
Carrier state None Yes Yes Yes None Likely Likely
Serologic
detection
Yes Yes Yes Yes Yes No No
Transmission Faeco-
oral
Blood
Sexual
Blood
Sexual
Blood
Sexual
Faeco-
oral
Blood
Sex
Blood
?Faeco-
Hepatitis Viruses (Cont)
Sexual
Perinatal
Sexual
Perinatal
Sexual Sex
Vertical
?Faeco-
oral
?Vertical
Hyper Ig
protection
Yes Yes ? Yes (B) None ? ?
Vaccine + + - (B) - - -
Antiviral
Treatment
- IFN
3TC
Adefovir
IFN
Ribavirin
- - - -
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Symptoms
ALTALT
Total anti-HAVTotal anti-HAV
Titer
Titer
Hepatitis A Virus InfectionTypical Serologic Course
Hepatitis A Virus InfectionTypical Serologic Course
FecalHAV
IgM anti-HAVIgM anti-HAV
Months after ExposureMonths after Exposure
Titer
Titer
0 1 2 3 4 5 6 12 24
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HBs
Ag
Hbe
Ag
Anti-HBc Anti
HBe
Anti
HBsInterpretation
IgM IgG
+ + - - - - Incubation period
+ + + + - - Acute hepatitis B infection
+ + - + - - Carrier state
+ - +/- + + - Carrier state
- - +/- + + + Convalescence
HBV
- - - + - + Recovery
- - + - - - HBV Infection without detectable HBsAg
- - - + - -
Possibilities:
(1) HBV infection in remote pass,
(2) “low level” HBV carrier
(3) “window” bet disappearance of HBsAg
and appearance of HBsAb,
(4) False positive or non specific reaction
- - - - - + Vaccine type response
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Common HBV Serology Patterns
Interpretation HBsAgAnti-
HBcIgM
Total
Anti-
HBc
Anti-
HBS
No evidence of HBV infection - - - -
Acute HBV infection + + + -
Chronic HBV (if HBsAg + for >6mths) + - + -Chronic HBV (if HBsAg + for >6mths) + - + -
(1)“Window” period
(2) HBV infection in remote pass,
(3) “low level” HBV carrier
(4) False positive
- + + -
Previous HBV infection - - + +
HBV vaccine response - - - +
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HBs
Ag
Anti HBc Anti
HBs
Anti-DeltaInterpretation
Total IgM Total IgM
+ + + - + + Acute coinfection with HBV and
Delta
+ + - - + +Acute Delta superinfection (anti-
Delta low), or chronic Delta
superinfection (anti-Delta low)
HDV
+ + - - + -
Recovery from acute Delta
superinfection (anti-Delta low), or,
rarely, chronic Delta
superinfection (anti-Delta level
high), usually without symptoms
- + - - + -Previous HBV and Delta infection
with probable recovery
- + - + + -Recovery from HBV and Delta
infection
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Streptavidin
Level 3+ anti-human IgG, strong positive
Level 1+ human IgG, moderate positive
Level + human IgG, weak positive
C1
INNO-LIA
C2
E2
NS3
NS4
NS5
HCV Antigens
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INNO-LIA
• Negative For HCV Ab-all HCV Ag lines negative
-only one HCV Ag lines + (except NS3)
• Positive For HCV Ab-at least 2 HCV Ag lines + or >-at least 2 HCV Ag lines + or >
• Indeterminate for HCV Ab-one HCV Ag line 1+ or >-NS3 + or >
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Interpreting HCV Test Results
Anti HCV/HCV infection Positive
(1) Anti-HCV screening test positive and RIBA/NAT positive; or
(2) Anti-HCV screening test positive, NAT negative, RIBA-positive
Anti-HCV/HCV infection Negative
(1) Anti-HCV screening test negative; or
(2) Anti-HCV screening test positive, RIBA negative
(3) Anti-HCV screening test positive, NAT negative, RIBA negative
Anti-HCV Indeterminate
An indeterminate anti-HCV result is defined as anti HCV screening test positive, RIBA indeterminate
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Algorithm For The Serologic Diagnosis Of HAV, HBV, HCV, HDV & HEV
Anti-HAV
IgM
Request anti-HAV IgG to
exclude previous infection*Recent HAV infectionNegative Positive
*Exclude recent transfusions, Ig, or maternal Ab
Anti-HEV
IgM
Request anti-HEV IgG to
exclude previous infection*
Recent HEV infectionNegative Positive
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Algorithm For The Serologic Diagnosis Of HAV, HBV, HCV, HDV & HEV
HCV infection unlikely
Request HCV RNA if
indicated
Anti- HCVActive or previous
HCV infection
HCV RNA
assay
Negative Positive
assay
Active
HCV
Previous HCV
suspected
Negative Positive
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Algorithm For The Serologic Diagnosis Of HAV, HBV, HCV, HDV & HEV
HBsAgNegative PositiveAnti-HBc
Total
No active HBV infection Indicates either active or
previous HBV infection
Negative Positive
Request anti-HBs test Request anti-HBs test
No previous
HBV infection
Vaccine type
response*
Active HBV
cannot be
excluded
Previous HBV
infection; immunity
confirmed*
*Exclude recent transfusions, Ig, or maternal Ab
Negative NegativePositive Positive
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Active HBV infection
either acute or chronic
HBsAgNegativePositive +anti-HBc positive
Anti-HBc
IgM
Anti-HDV
IgG
Recent / Chronic
Negative PositiveHDV
HBeAg
Anti-HBeNo active
HDV Anti-HDV
Positive Negative
NegativeRecent /
Ac HBV
infection
Chronic
HBV
infection
Anti-HBe
HBV
infectivity is
relatively high
HBV
infectivity is
relatively low
Anti-HBe
positive
HBeAg
positive
Neither
positive
HDV infection
acute or chronic
HDV
infection
Anti-HDV
IgM/
HDVRNA
Negative
Positive