Chronic Hepatitis B. What every GP should know. Prof Ed Gane NZ Liver Unit
|
|
- Oswald Miles
- 6 years ago
- Views:
Transcription
1 Chronic Hepatitis B What every GP should know Prof Ed Gane NZ Liver Unit
2 Case 1 55 Yr old Tonga male»well but dad died of liver cancer»lfts: ALT 85, GGT 60; ALP 75; bilirubin 12 What next?
3 Case 1 55 Yr old Tonga male»well but dad died of liver cancer»lfts: ALT 85, GGT 60; ALP 75; bilirubin 12 HBsAg + HBeAg neg What next?
4 Case 1 55 Yr old Tonga male»well but dad died of liver cancer»lfts: ALT 85, GGT 60; ALP 75; bilirubin 12 HBsAg + HBeAg neg HBV DNA 6,500,000 IU/mL What next?
5 Case 1 55 Yr old Tonga male»well but dad died of liver cancer»lfts: ALT 85, GGT 60; ALP 75; bilirubin 12 HBsAg + HBeAg neg HBV DNA 6,500,000 IU/mL Referred to Hospital Fibroscan cirrhosis Treat?
6 Case 2 35 Yr old European male» 2 weeks malaise, anorexia»now dark urine, RUQ abdo pain,» Previously well, no family history»lfts: ALT 1600, GGT 160; ALP 95; bilirubin 122 New partner Chinese tertiary student who has strong family history of liver cancer What next?
7 Case 2 35 Yr old European male» 2 weeks malaise, anorexia»now dark urine, RUQ abdo pain,» Previously well, no family history»lfts: ALT 1600, GGT 160; ALP 95; bilirubin 122 New partner Chinese tertiary student who has strong family history of liver cancer Anti-HAV IgM neg Anti-HCV neg HBsAg neg; anti-hbs neg What next?
8 Case 2 35 Yr old European male» 2 weeks malaise, anorexia»now dark urine, RUQ abdo pain,» Previously well, no family history»lfts: ALT 1600, GGT 160; ALP 95; bilirubin 122 New partner Chinese tertiary student who has strong family history of liver cancer Anti-HAV IgM neg Anti-HCV neg HBsAg neg; anti-hbs neg Anti-HBcore IgM ++ What next?
9 window Diagnosis of Acute Hepatitis B Symptoms anti-hbs Titre IgM anti-hbc Total anti-hbc HBsAg Weeks after Exposure
10 Diagnosis of Chronic Hepatitis B Acute (6 months) HBeAg HBsAg Chronic (Years) Titre Total anti-hbc IgM anti- HBc Years Weeks after Exposure
11 ACUTE HBV early window late HB s Ag anti-hbs HB e Ag anti-hbe anti-hb c IgM anti-hb c IgG Serum ALT >5x ULN HBV DNA /- /-
12 ACUTE HBV CHRONIC HBV early window late eag+ eag - HB s Ag anti-hbs HB e Ag anti-hbe anti-hb c IgM anti-hb c IgG Serum ALT >5x ULN >ULN HBV DNA /- /-
13 ACUTE HBV CHRONIC HBV IMMUNE early window late eag+ eag - past HBV vaccine HB s Ag anti-hbs HB e Ag anti-hbe anti-hb c IgM anti-hb c IgG Serum ALT >5x ULN >ULN < ULN HBV DNA /- /-
14 ACUTE HBV CHRONIC HBV IMMUNE early window late eag+ eag - past HBV vaccine HB s Ag anti-hbs HB e Ag anti-hbe anti-hb c IgM anti-hb c IgG Serum ALT >5x ULN >ULN < ULN HBV DNA /- /-
15 ACUTE HBV CHRONIC HBV IMMUNE early window late eag+ eag - past HBV vaccine HB s Ag anti-hbs HB e Ag anti-hbe anti-hb c IgM anti-hb c IgG Serum ALT >5x ULN >ULN < ULN HBV DNA /- /-
16 Route of acquisition of Chronic HBV infection in NZ Adult to Adult Maternal 1% 10% Playground 89% Vaccine available, cheap, >99% effective
17 Control of HBV in New Zealand Neonatal Vaccination Program (1987) % HBsAg+ in 12 yr olds 20% 15% 10% 10% 5% 0% 0% (vaccinated) Lucas et al. NZ Med J 1994; 107:266-8
18 HCC incidence in children (<14yrs) (100,000 person yrs) Childhood Vaccination in Taiwan reduces incidence of Liver Cancer 0.8 neonatal vaccine '75 '76 '77 '78 '79 '80 '81 '82 '83 '84 '85 '86 '87 Birth Year Chang,1997
19 Cost/QALYS Childhood Vaccination is the most costeffective health intervention $ 50,000 $ 40,000 $38,000 $ 30,000 $ 30,000 $ 25,000 $23,000 $ 20,000 $ 10,000 $ 0 $200 Cervical Cancer Screen Breast Cancer Screen Colonic Cancer Screen HCC screening in HBsAg+ HBV Vaccine
20 Roll out of HBV Vaccination: Milestones 1985: International Vaccination Workshop» Saul Krugman, Palmer Beazley, Ron Lucas, Mary Dimitrikakas, Brian McMahon, Jim Maynard 1986: Vaccinate infants of HBsAg+ mothers 1987: Vaccinate all infants (80,000/year) 1988: Catch-up vaccination in all 12 yr olds What about those already infected?
21 Impact of Endemic HBV Infection in New Zealand LIVER MORTALITY HEPATOMA CLINIC Alcohol 31% Other 4% HCV 21% Alcohol 9% NASH 7% Other 3% HCV 8% \ HBV 63% HBV 60% 200 cases per annum 120 cases per annum Weir,R, et al. J Gastro Hepatol 2002;17: Fung J, et al. Hepatology 2005; 42:258A
22 NZ Maori Cook Islands Fiji W. Samoa Niue Tonga Hong Kong Taiwan SE China Prevalence of HBsAg Who should be included in a National HBV Screening Programme? Prevalence of HBV Incidence of HCC 25% 20% 15% 10% 5% China Middle Africa Japan Eastern Africa Southern Europe Caribbean Southern Africa Western Europe Eastern Europe Northern America Central America Western Asia Northern Africa Australia South America Northern Europe Males Females 0% NZ Maori NZ Asian NZ Pacifican HCC Age Standardized Incidence per 100,000 Parkin D, et al. CA Cancer J Clin. 2005;55; Tuikitonga C, et al. NZMJ 1992.
23 Projected Ethnic Populations (i) Maori (ii) Pacific (iii) Asian (iv) European
24 National HBV Screening Programme June 1998: Pilot programme scrapped National screening programme funded from July 1999 until June 2002 Targeting at-risk adults» Asian, Pacific Islander, Maori» 15 years old (post vaccination) Total to be screened= 566,000 All HBsAg+ offered life-long follow-up
25 HBV Status National HBV Screening Programme July July 2002» 177,292 Screened 75% 50% 25% 0% 11,936 HBsAg+ identified 54% 59% 59% 45% 6.5% 5.8% 7.3% 6.2% 9% 1% Overall Maori Pacifican Asian European anti-hbs(+) = immune to HBV HBsAg+ = chronic HBV Robinson T, et al. NZ Med J. 2005; 118: No. 1211
26 Maori Cook Is Niuean Tongan Indian (50,000) SE Asian (20,000) Chinese (72,500) % HBsAg+ National HBV Screening Programme Prevalence according to Ethnicity 20% 15% 13.3% 10% 5.8% 7.4% 9.1% 9.3% 9.4% 5% 0% 0.6% Robinson T, et al. NZ Med J. 2005; 118: No. 1211
27 National HBV Follow-up Programme Opportunistic screening in Primary Care Total enroled pre
28 Numbers lost from f/u Numbers exiting from the National HBV Surveillance Programme sag loss Emigrated Died Refused
29 National HBV Screening Programme : MoH-funded screening programme»enrolled 11,300 HBsAg+ Since 2002: MoH surveillance programme»lost 3500 from original cohort»gained 6000 from opportunistic screening»currently 18,000 enrolled
30 NZ Hepatitis B Screening and Follow-up Programme HBsAg Negative Immune Nonimmune DISCHARGE VACCINATE HBsAg Positive THF Follow-up Programme 6 mthly surveillance for CHB and HCC Robinson T, et al. NZ Med J. 2005; 118: No. 1211
31 National HBV Follow-up Programme Surveillance for Hepatoma Screening Programme Regular surveillance 6 monthly AFP ± U/S ALL HBsAg+ Not Screened No surveillance Present with symptoms
32 National HBV-HCC Surveillance Programme Outcomes to date ( ) Patients in the NZ HBV Screening Program 284 HCCs Detected at screening visit Detected between visits Patients NOT enrolled in HBV Screening Program 374 Non-screened HCCs All symptomatic
33 % of patients treated National HBV-HCC Surveillance Programme Increase in curative treatment for HCC Surveillance detects HCC earlier 80 and increases treatment options Screened HBV-HCC (n=190) Non-screened HBV-HCC (n=375) 79% P< % 25% 17% 13% 9% 5% 4% 1% 0% TACE/TAE RFA Resection Liver Tx Overall Treatment Modality
34 Cumulative Survival National HBV-HCC Surveillance Programme Increase in survival for HCC % 54% Screened HBV group Median survival = 2054 days n = Surveillance Log-rank: P< increases survival 20 21% 3% Non-screened HBV group Median survival = 99 days n = Survival (Years)
35 ANTIVIRAL THERAPY National HBV Follow-up Programme Surveillance for Chronic Hepatitis B ALL HBsAg+ 6 monthly ALT ALT>ULN Repeat in 3 months ALT>ULN Refer to Clinic HBV DNA >4 log IU/mL
36 Goals of treatment in CHB: APASL Consensus Statement 2005 The ultimate long-term goal is prevention of cirrhosis, decompensation and HCC, and prolong survival. Sustained viral suppression is the key to the reduction or prevention of hepatic injury and disease progression. Therefore, the primary goal of treatment for chronic hepatitis B is to eliminate or permanently suppress HBV.. Liaw YF et al. Liver Int 2005
37 (a) L-Nucleosides NH 2 Options for Treating CHB O N N CH HN 3 N NH 2 F HO S N O O N O OH O N O OH S Lamivudine OH Telbivudine Emtricitabine (b) D-Cyclopentane (c) Acyclic Phosphonate NH 2 HO HN N N N N Entecavir NH 2 N NH 2 N N N O Adefovir O O P OH OH N N O O P OH OH Tenofovir OH
38 Resistance to nucleoside analogues Treatment-naive % resistant LAM ADV LdT ETV TDV Year 6 Year 5 Year 4 Year 3 Year 2 Year 1 0 0
39 Proportion of Subjects, % Benefits of Long-term Oral Antiviral Therapy Suppression of HBV Replication HBeAg- Patients HBeAg+ Patients % % 90 TDF-TDF 80 TDF-TDF 70 ADV-TDF 60 ADV-TDF Weeks Weeks 99.6% overall response at Year 8 98% overall response at Year 8 1. Marcellin P, et al. J Hepatol Jul 18; DOI: /j.jhep (epub ahead of print). 39
40 Benefits of Long-term Oral Antiviral Therapy Reversal of Fibrosis Pre-treatment Cirrhosis After 3 years Tenofovir Mild Fibrosis Dienstag,2003
41 HCC Incidence (%) Benefits of Long-term Oral Antiviral Therapy Prevention of Liver Cancer Case-control Korean study (2518 patients): 0.4 Control Group P = Suppressed on Lamivudine Years Follow-up Eun JR et al. J Hepatol 2010; 53:
42 Number of Transplants Benefits of Long-term Oral Antiviral Therapy Demand for Liver Transplantation NZLTU Trends in HBV Transplants ( ) 602 liver transplants; 121 (20%) for HBV Decomp 15 Lamivudine Adefovir Tenofovir / /2 2003/4 2005/6 2007/8 2009/ / /4 NZLTU data
43 Benefits of Long-term Oral Antiviral Therapy for CHB Mortality reduction Transplant need reduction HCC reduction Cirrhosis reduction Histological response Serological response Histological response Serological response Virological response Biochemical response Fibrosis regression HBsAg seroclearance Histological improvement HBeAg loss-seroconversion (HBeAg(+) patient only) HBV DNA negativity ALT normalisation Short-term goal Medium-term goal Long-term goal Treatment start Su TH, et al. Expert Rev Gastroenterol Hepatol 2014; doi: /
44 Management of HBV in NZ Summary 100,000 infected here in NZ»Only 1/3 are aware of their status»only 20% in long-term surveillance 300+ deaths/yr 1000/yr by 2030»Most due to HCC (liver cancer)»all preventable by earlier diagnosis Need to restart targeted HBV screening in all adult Maori, Pacific, Asian New Zealanders»Opportunistic screening in primary care»open national screening programme?
45 Management of HBV in NZ Summary Suppression of HBV with antiviral therapy prevents disease progression and reverses liver cirrhosis thereby reducing liver cancer Current treatments (entecavir, tenofovir) are safe and 100% effective and fully funded for life Regular surveillance and monitoring of patients with HBV will provide earlier detection of liver cancer and improved chance of cure
46 Number of HBV-HCC Management of HBV in NZ Unresolved issues Almost 50% HCCs are only diagnosed when symptoms develop, when cure is not possible Not screen-detected Screen-detected 50 Need to increase recruitment into followup programme through primary care Need to improve the effectiveness of 20 surveillance, by using new predictors of 10 HCC to individualise monitoring strategies
47
48 Hepatitis Foundation of New Zealand The Story So Far?
49 History so far Established 31 years ago Charitable Trust Head office in Whakatane Largest HBV follow-programme globally Employs 28 staff Has over 18,000 clients registered in long-term follow-up Works in partnership with the NZ Liver Unit Provides community Fibroscan Service
50 Liver biopsy Day off work in 100% Pain, tenderness in 100% Haemorrhage in 1% Bile leak in 0.5% Overnight admission in 5% Surgery in 1% Death in 0.3% van der Poorten E, et al. Int Med J 2006; 36:
51 Fibroscan No days off work Non-invasive» Painless» No admissions/deaths Bedside/clinic Immediate result Inexpensive Reproducible
52 Why use the Hepatitis Foundation? Expertise in HBV management & education Better outcomes for HBV patients enrolled into national follow-up programme Community Service Advice line up-to-date information Safety net for both patients & GP National HBV Patient Management System
53 National HBV Surveillance Programme Hep Foundation contracted by MoH since 2002 Still GP-based but community nurse available to chase repeated nonresponders to recall Facilitated collection Preprinted blood forms or HepBFree stickers Central database (updated SQL) Efficiency Quality assurance; effectiveness analysis GPs can now e-refer to the Foundation via Medtech, Best Practice and Care Select
54 How to refer from Primary Care Letter Telephone Fax Hep Foundation Community Nurse Hep Foundation e-referral via Medtech Best Practice Care Select Self referral
55
56
57 HBV the solution Universal neonatal vaccination will prevent >99% new infections and will lead to global eradication of HBV within the next 50 years For those who are already infected, long-term antiviral therapy will prevent all liver-related complications and is safe In near future, the addition of short-term HBV CURE therapies will induce HBsAg loss and allow cessation of long-term therapy
Chronic Hepatitis B. What every GP should know. Prof Ed Gane NZ Liver Unit
Chronic Hepatitis B What every GP should know Prof Ed Gane Z Liver Unit Case 1 55 Yr old Tonga male»well but dad died of liver cancer»lfts: ALT 85, GGT 60; ALP 75; bilirubin 12 What next? Case 1 55 Yr
More informationHBV in New Zealand Community HBV screening to long-term follow-up
HBsAg+ icteric hepatitis (n) % anti-hbcore+ 26/9/214 HBV in New Zealand Community HBV screening to long-term follow-up John Hornell, CEO, A registered charitable trust whose mission is: To improve health
More informationHepatitis B screening and surveillance in primary care
Hepatitis B screening and surveillance in primary care Catherine Stedman Associate Professor of Medicine, University of Otago, Christchurch Gastroenterology Department, Christchurch Hospital Disclosures
More informationViral Hepatitis. Dr Melissa Haines Gastroenterologist Waikato Hospital
Viral Hepatitis Dr Melissa Haines Gastroenterologist Waikato Hospital Viral Hepatitis HAV HBV HCV HDV HEV Other viral: CMV, EBV, HSV Unknown Hepatitis A Hepatitis A Transmitted via the faecal-oral route
More informationCornerstones of Hepatitis B: Past, Present and Future
Cornerstones of Hepatitis B: Past, Present and Future Professor Man-Fung Yuen Queen Mary Hospital The University of Hong Kong Hong Kong 1 Outline Past Natural history studies Development of HBV-related
More informationDoes Viral Cure Prevent HCC Development
Does Viral Cure Prevent HCC Development Prof. Henry LY Chan Head, Division of Gastroenterology and Hepatology Director, Institute of Digestive Disease Director, Center for Liver Health Assistant Dean,
More informationManagement of Hepatitis B - Information for primary care providers
Management of Hepatitis B - Information for primary care providers July 2018 Chronic hepatitis B (CHB) is often a lifelong condition. Not everyone infected needs anti-viral therapy. This document outlines
More informationTreatment as a form of liver cancer prevention The clinical efficacy and cost effectiveness of treatment across Asia
Treatment as a form of liver cancer prevention The clinical efficacy and cost effectiveness of treatment across Asia Prof. Henry LY Chan Head, Division of Gastroenterology and Hepatology Director, Institute
More informationDr David Rowbotham NHS. The Leeds Teaching Hospitals. NHS Trust
Dr David Rowbotham The Leeds Teaching Hospitals NHS Trust NHS Nurses Update June 2010 Chronic Hepatitis HBV / HCV David Rowbotham Clinical Director & Consultant Gastroenterologist Dept of Gastroenterology
More informationManagement of Chronic Hepatitis B in Asian Americans
Management of Chronic Hepatitis B in Asian Americans Myron J Tong; UCLA, CA Calvin Q. Pan; Mount Sinai, NY Hie-Won Hann; Thomas Jefferson, PA Kris V. Kowdley; Virginia Mason, WA Steven Huy B Han; UCLA,
More informationHepatitis B Virus-Related Hepatocellular Carcinoma Presenting at an Advanced Stage: Is it Preventable? Dr Tom Mules NZSG ASM 2018
Hepatitis B Virus-Related Hepatocellular Carcinoma Presenting at an Advanced Stage: Is it Preventable? Dr Tom Mules NZSG ASM 2018 HCC Males Females Ferlay et al. Cancer incidence and mortality worldwide:
More informationTenofovir as a drug of choice for the chronic hepatitis B treatment
EASL endorsed conference White Nights of Hepatology 2013 Symposium Perspectives of chronic viral hepatitis B and C treatment June 6-7 Saint-Petersburg Tenofovir as a drug of choice for the chronic hepatitis
More informationManagement of Decompensated Chronic Hepatitis B
Management of Decompensated Chronic Hepatitis B Dr James YY Fung, FRACP, MD Department of Medicine The University of Hong Kong Liver Transplant Center Queen Mary Hospital State Key Laboratory for Liver
More informationUpdate on Hepatitis B and Hepatitis C
Update on Hepatitis B and Hepatitis C Catherine Stedman Department of Gastroenterology, Christchurch Hospital and University of Otago, Christchurch Disclosures I have the following financial relationships
More informationESCMID Online Lecture Library. by author
Pro-Con: To stop or not to stop hepatitis B treatment? To Stop HBV Treatment Resat Ozaras, MD, Professor Istanbul University, Cerrahpasa Medical School, Infection Dept. HBV Therapy Nucleos(t)ide analogues
More informationCommunity/GP based screening & management of HBV & HCV
Community/GP based screening & management of HBV & HCV Catherine Stedman Department of Gastroenterology, Christchurch Hospital and University of Otago, Christchurch Disclosures I have the following financial
More informationHepatitis B Virus therapy. Maria Buti Hospital Universitario Valle Hebron Barcelona Spain
Hepatitis B Virus therapy Maria Buti Hospital Universitario Valle Hebron Barcelona Spain Disclosures Advisor: AbbVie, Boehringer Ingelheim, Bristol-Myers Squibb, Gilead Sciences, Janssen, Merck Sharp &
More informationHepatitis B. ECHO November 29, Joseph Ahn, MD, MS Associate Professor of Medicine Director of Hepatology Oregon Health & Science University
Hepatitis B ECHO November 29, 2017 Joseph Ahn, MD, MS Associate Professor of Medicine Director of Hepatology Oregon Health & Science University Disclosures Advisory board Gilead Comments The speaker Joseph
More informationDiscontinuation of Nucleotide or Nucleoside Analogue therapy for Chronic Hepatitis B infection
Discontinuation of Nucleotide or Nucleoside Analogue therapy for Chronic Hepatitis B infection Dr Abid Suddle Institute of Liver Studies King s College Hospital Why consider discontinuation of NA therapy?
More informationCommunity/GP based screening & management of HBV & HCV
Community/GP based screening & management of HBV & HCV Catherine Stedman Department of Gastroenterology, Christchurch Hospital and University of Otago, Christchurch Disclosures I have the following financial
More informationMarch 29, :15 PM 1:15 PM San Diego, CA Convention Center Ballroom 20D
March 29, 2017 12:15 PM 1:15 PM San Diego, CA Convention Center Ballroom 20D Provided by #IM2017 This lunch symposium is not part of the official Internal Medicine Meeting 2017 Education Program. #IM2017
More informationChronic Hepatitis B: management update.
Chronic Hepatitis B: management update. E.O.Ogutu Department of clinical medicine & therapeutics, University of Nairobi. Physicians meeting,kisumu 2011. Background epidemiology Chronic hepatitis B (CHB)
More informationHBV NATURAL HISTORY. Mitchell L. Shiffman, MD Director Liver Institute of Virginia Bon Secours Health System Richmond and Newport News, Virginia
HBV NATURAL HISTORY AND MANAGMENT Mitchell L. Shiffman, MD Director Liver Institute of Virginia Bon Secours Health System Richmond and Newport News, Virginia IVer Liver Institute of Virginia Education,
More informationHepatitis B. What's the impact on the risk? Dr Himanshu Bhatia, Asia Chief Medical Officer ALUCA, Brisbane, Sept 2013
Hepatitis B What's the impact on the risk? Dr Himanshu Bhatia, Asia Chief Medical Officer ALUCA, Brisbane, Sept 2013 Some quick facts about Hepatitis B Worldwide: 350-400 Million are chronic infections
More informationHepatitis B Virus therapy. Maria Buti Hospital Universitario Valle Hebron Barcelona Spain
Hepatitis B Virus therapy Maria Buti Hospital Universitario Valle Hebron Barcelona Spain Disclosures Advisor: AbbVie, Boehringer Ingelheim, Bristol-Myers Squibb, Gilead Sciences, Janssen, Merck Sharp &
More informationHBV Diagnosis and Treatment
HBV Diagnosis and Treatment Anna S. F. Lok, MD Alice Lohrman Andrews Professor in Hepatology Director of Clinical Hepatology Assistant Dean for Clinical Research University of Michigan Ann Arbor, MI, USA
More informationAcute Hepatitis B Virus Infection with Recovery
Hepatitis B: Clear as Mud Melissa Osborn, MD, MSCR Assistant Professor Emory University School of Medicine Atlanta, GA 1 Objectives 1. Distinguish the various stages in the natural history of chronic hepatitis
More informationCURRENT TREATMENT. Mitchell L Shiffman, MD Director Liver Institute of Virginia Bon Secours Health System Richmond and Newport News, Virginia
CURRENT TREATMENT OF HBV Mitchell L Shiffman, MD Director Liver Institute of Virginia Bon Secours Health System Richmond and Newport News, Virginia CHRONIC HBV INFECTION DEMOGRAPHICS IN THE USA Estimated
More informationHBV Therapy in Special Populations: Liver Cirrhosis
HBV Therapy in Special Populations: Liver Cirrhosis Universitätsklinikum Leipzig Thomas Berg Sektion Hepatologie Klinik und Poliklinik für Gastroenterologie und Rheumatologie Leber- und Studienzentrum
More informationHepatitis B and D Update on clinical aspects
Hepatitis B and D Update on clinical aspects B. Müllhaupt Gastroenterology and Hepatology Swiss Transplant and HPB-Center University Hospital Zurich beat.muellhaupt@usz.ch B.M. 11.11.17 Hepatitis Strategy
More informationChoice of Oral Drug for Hepatitis B: Status Asokananda Konar
Choice of Oral Drug for Hepatitis B: Status 2011 Asokananda Konar Chronic hepatitis B (CHB) is a global public health challenge with an estimated 350 to 400 million people with chronic HBV infection, despite
More informationThe Impact of HBV Therapy on Fibrosis and Cirrhosis
The Impact of HBV Therapy on Fibrosis and Cirrhosis Jordan J. Feld, MD, MPH Associate Professor of Medicine University of Toronto Hepatologist Toronto Centre for Liver Disease Sandra Rotman Centre for
More informationAn Update HBV Treatment
An Update HBV Treatment Epidemiology Natural history Treatment Daryl T.-Y. Lau, MD, MPH Associate Professor of Medicine Director of Translational Liver Research Division of Gastroenterology BIDMC, Harvard
More informationHBV in HIV Forgotten but not Gone
Activity Code FA376 HBV in HIV Forgotten but not Gone Richard K. Sterling, MD, MSc VCU Hepatology Professor of Medicine Chief, Section of Hepatology Virginia Commonwealth University Learning Objectives
More informationNovedades en el tratamiento de la hepatitis B: noticias desde la EASL. Maria Buti Hospital Universitario Valle Hebrón Barcelona
Novedades en el tratamiento de la hepatitis B: noticias desde la EASL Maria Buti Hospital Universitario Valle Hebrón Barcelona Milestones in CHB treatment Conventional IFN 1991 Lamivudine (LAM) 1998 Adefovir
More informationHepatocellular Carcinoma: Can We Slow the Rising Incidence?
Hepatocellular Carcinoma: Can We Slow the Rising Incidence? K.Rajender Reddy M.D. Professor of Medicine Director of Hepatology Medical Director of Liver Transplantation University of Pennsylvania Outline
More informationHepatitis B. Epidemiology and Natural History and Implications for Treatment
Hepatitis B Epidemiology and Natural History and Implications for Treatment Norah Terrault, MD Professor of Medicine and Surgery Director, Viral Hepatitis Center University of California San Francisco
More informationDisclaimer. Presenter Release are for reactive use by Medical Information only internal learning/educational use only
Disclaimer Presenter Release are for reactive use by Medical Information only internal learning/educational use only Any unsolicited request from HCP must be forwarded to Medical Information Housekeeping
More informationHepatitis B Update. Jorge L. Herrera, M.D. University of South Alabama Mobile, AL. Gastroenterology
Hepatitis B Update Jorge L. Herrera, M.D. University of South Alabama Mobile, AL Deciding Who to Treat Is hepatitis B a viral disease or a liver disease? Importance of HBV-DNA Levels in the Natural History
More informationEASL Clinical Practice Guidelines: Management of chronic hepatitis B virus infection
EASL Clinical Practice Guidelines: Management of chronic hepatitis B virus infection European Association for the Study of the Liver Introduction Our understanding of the natural history of hepatitis B
More informationClinical Case Maria Butí, MD, PhD
Clinical Case Maria Butí, MD, PhD Liver Unit, Internal Medicine Department Vall d Hebron Hospital 1 Clinical Case 70 year-old male Smoker, no alcohol intake No risk factors Diabetes Mellitus treated with
More informationBasics of hepatitis B diagnostics. Dr Emma Page MRCP MD(Res) Locum Consultant Sexual Health & Virology
Basics of hepatitis B diagnostics Dr Emma Page MRCP MD(Res) Locum Consultant Sexual Health & Virology Basics of hepatitis B diagnostics Background Epidemiology Morphology Life-cycle Diagnostic markers
More informationManagement of chronic hepatitis B : recent advance in the treatment of antiviral resistance
anagement of chronic hepatitis B : recent advance in the treatment of antiviral resistance / 김강모 연수강좌 anagement of chronic hepatitis B : recent advance in the treatment of antiviral resistance 김강모 울산대학교의과대학서울아산병원소화기내과
More informationClinical dilemmas in HBeAg-negative CHB
Clinical dilemmas in HBeAg-negative CHB George V. Papatheodoridis Professor in Medicine & Gastroenterology Medical School of National & Kapodistrian University of Athens Director of Academic Department
More informationChronic Hepatitis B Infection
Chronic Hepatitis B Infection Mohssen Nassiri Toosi, MD Imam Khomeinin Hospital Tehran University of Medical Sciences Chronic Hepatitis B Infection Virus : HBs Ag Positive Host Liver Health Chronic Hepatitis
More informationHepatitis B Treatment Pearls. Agenda
Hepatitis B Treatment Pearls Fredric D. Gordon, MD Vice Chair Dept. of Transplantation and Hepatobiliary Diseases Lahey Hospital & Medical Center Associate Professor of Medicine Tufts Medical School Boston,
More informationLandmarks for Prevention and Treatment
HBeAg-positive chronic hepatitis B Why do I treat my patient with a nucleos(t)ide analogue? Dr. Nancy Leung BSc(Lon) MSc(Lon) MBBS(Lon) MD(Lon), FRCP(Lon) FRCP(Edin) FHKCP FHKAM Consultant Physician, Alice
More informationHepatitis B: A Preventable Cause of Liver Cancer. Saira Khaderi MD, MPH Assistant Professor of Surgery Associate Director, Project ECHO June 17, 2016
Hepatitis B: A Preventable Cause of Liver Cancer Saira Khaderi MD, MPH Assistant Professor of Surgery Associate Director, Project ECHO June 17, 2016 Overview Epidemiology HBV and cancer Screening, Diagnosis
More informationOptimized HBV Treatment Through Baseline and on-treatment Predictor Oral Antiviral Therapy. Watcharasak Chotiyaputta
Optimized HBV Treatment Through Baseline and on-treatment Predictor Oral Antiviral Therapy Watcharasak Chotiyaputta Progression of Liver Disease Goal of HBV Treatment: prevention the development of cirrhosis
More informationViral Hepatitis The Preventive Potential of Antiviral Therapy. Thomas Berg
Viral Hepatitis The Preventive Potential of Antiviral Therapy Thomas Berg Therapeutic and preventive strategies in patients with hepatitis virus infection Treatment of acute infection Treatment of chronic
More informationHepatitis B infection
Hepatitis B infection Kenneth Kabagambe Executive Director The National Organization for People Living with Hepatitis B (NOPLHB Uganda General introduction: Viral hepatitis in Uganda Viruses that affect
More informationViral hepatitis and Hepatocellular Carcinoma
Viral hepatitis and Hepatocellular Carcinoma Hashem B. El-Serag, MD, MPH Dan L. Duncan Professor of Medicine Chief, Gastroenterology and Hepatology Houston VA & Baylor College of Medicine Houston, TX Outline
More informationRecent achievements in the treatment of hepatitis B by nucleosides and nucleotides. K. Zhdanov
EASL endorsed conference White Nights of Hepatology 2012 Adverse events during antiviral therapy: how to predict, manage and monitor June 7-8 Saint-Petersburg Recent achievements in the treatment of hepatitis
More informationNatural History of Chronic Hepatitis B
Natural History of Chronic Hepatitis B Anna SF Lok, MD Alice Lohrman Andrews Professor in Hepatology Director of Clinical Hepatology Assistant Dean for Clinical Research University of Michigan Ann Arbor,
More informationPrediction of HBsAg Loss by Quantitative HBsAg Kinetics during Long-Term 2015
THAI J 16 GASTROENTEROL Treatment with Nucleos(t)ide Original Analogues Article Prediction of HBsAg Loss by Quantitative HBsAg Kinetics during Long-Term Treatment with Nucleos(t)ide Analogues Sombutsook
More informationFor now, do not stop NUCs PHC R. PARANÁ Federal University of Bahia, Brazil HUPES-University Hospital Gastro-Hepatology Unit
For now, do not stop NUCs PHC 2019 R. PARANÁ Federal University of Bahia, Brazil HUPES-University Hospital Gastro-Hepatology Unit Disclosure PI: Clinical Trials -ABBVIE -INTERCEPT -GILEAD -Novartis -BMS
More informationWho to Treat? Consider biopsy Treat. > 2 ULN Treat Treat Treat Treat CIRRHOTIC PATIENTS Compensated Treat HBV DNA detectable treat
Who to Treat? Parameter AASLD US Algorithm EASL APASL HBV DNA CRITERIA HBeAg+ >, IU/mL > 2, IU/mL > 2, IU/mL >, IU/mL HBeAg- > 2, IU/mL > 2, IU/mL > 2, IU/mL > 2, IU/mL ALT CRITERIA PNALT 1-2 ULN Monitor
More informationHow to use pegylated Interferon for Chronic Hepatitis B in 2015
How to use pegylated Interferon for Chronic Hepatitis B in 215 Teerha Piratvisuth NKC Institute of Gastroenterology and Hepatology Prince of Songkla University, Thailand ASIAN-PACIFIC CLINICAL PRACTICE
More informationNATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE
NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE Centre for Clinical Practice SCOPE Clinical guideline title: Hepatitis B (chronic): diagnosis and management of chronic hepatitis B in children, young
More informationProfessor Vincent Soriano
Five Nations Conference on HIV and Hepatitis in partnership with Professor Vincent Soriano Hospital Carlos III, Madrid, Spain Professor Vincent Soriano in partnership with Hospital Carlos III, Madrid,
More informationGAZETTE COMMON GROUND. CHB: A significant and prevalent disease in the US and worldwide. Inside. Screening, diagnosis, and evaluation
VOL III/III COMMON GROUND GAZETTE Inside CASE 1: Screening, diagnosis, and evaluation P. 1 CASE 2: Initiating treatment P. 4 CASE 3: Managing antiviral resistance P. 5 CASE 4: Achieving the maximum effect
More informationEAST LONDON INTEGRATED CARE
CITY & HACKNEY ELIC EAST LONDON INTEGRATED CARE MANAGEMENT OF CHRONIC HEPATITIS B IN PRIMARY CARE Chronic Hepatitis B virus (HBV) is an important public health problem globally and a leading cause of liver
More informationViral hepatitis Prevention Board. Clinical aspects of hepatitis B
Viral hepatitis Prevention Board Clinical aspects of hepatitis B Natural History and serological markers acute and chronic hepatitis B Acute hepatitis B Immune response Immunological tolerance Resolution
More informationHow find a solution for alternative to indefinite nucleoside analogue therapy in patients chronic HBV infection?
How find a solution for alternative to indefinite nucleoside analogue therapy in patients chronic HBV infection? Philippe Halfon, MD,PhD Associate Professor of Medicine Hôpital Europeen Marseille, France
More informationDon t interfere My first choice is always nucs!
Don t interfere My first choice is always nucs! Robert G Gish MD Professor Consultant Stanford University Medical Director, Hepatitis B Foundation Singapore Viral Hepatitis Meeting 2014 1 Disclosures Dr
More informationConsiderations for Antiretroviral Use in Patients with Hepatitis B Virus & Human Immunodeficiency Syndrome Coinfection
Considerations for Antiretroviral Use in Patients with Hepatitis B Virus & Human Immunodeficiency Syndrome Coinfection Mahnaz Arian, MD Assistant Professor in infectious Disease Mashhad university of Medical
More informationHBeAg-negative chronic hepatitis B. with a nucleos(t)ide analogue?
4 th PARIS HEPATITIS CONFERENCE HBeAg-negative chronic hepatitis B Why do I treat my chronic hepatitis B patients with a nucleos(t)ide analogue? George V. Papatheodoridis, MD 2nd Department of Internal
More informationNUCs for Chronic Hepatitis B. Rafael Esteban Hospital Universitario Valle Hebron and Ciberehd del Instituto Carlos III. Barcelona.
NUCs for Chronic Hepatitis B Rafael Esteban Hospital Universitario Valle Hebron and Ciberehd del Instituto Carlos III. Barcelona. Spain Disclosures Advisory board of, and/or, received speaker fee from
More informationChronic HBV Management in 2013
Chronic HBV Management in 2013 Mohammad Hossein Somi MD Professor of Gastroentrology and hepatology Liver and Gastrointestinal Disease Research Center Tabriz University of Medical Sciences 1 HBV in 2013
More informationUpdate on HBV Treatment
Update on HBV Treatment Calvin Q. Pan MD, FAASLD, FACG, MACP Professor of Medicine Division of Gastroenterology and Hepatology Department of Medicine, NYU Langone Health New York University School of Medicine,
More informationentecavir, 0.5mg and 1mg film-coated tablets and 0.05 mg/ml oral solution, Baraclude SMC No. (747/11) Bristol-Myers Squibb Pharmaceuticals Ltd
entecavir, 0.5mg and 1mg film-coated tablets and 0.05 mg/ml oral solution, Baraclude SMC No. (747/11) Bristol-Myers Squibb Pharmaceuticals Ltd 09 December 2011 The Scottish Medicines Consortium (SMC) has
More informationNATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE
NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE Centre for Clinical Practice SCOPE Clinical guideline title: Hepatitis B (chronic): diagnosis and management of chronic hepatitis B in children, young
More informationGish RG and AC Gadano. J Vir Hep
Treatment in Hepatitis B and C There are options! Karen F. Murray, MD Professor of Pediatrics Director, Hepatobiliary Program Seattle Children s Hepatitis B Virus Epidemiology and natural history 400
More informationOur better understanding of the natural
TREATMENT OF CHRONIC HEPATITIS B: MASTERING THE BASICS ON A COMPLEX TOPIC Ke-Qin Hu, MD* ABSTRACT The availability of newer antiviral agents, as well as comprehensive treatment recommendations, has equipped
More informationHepatitis B Virus. Taylor Page PharmD Candidate 2019 February 1, 2019
Hepatitis B Virus Taylor Page PharmD Candidate 2019 February 1, 2019 Epidemiology 3218 cases of acute HBV reported in 2016 847,000 non-institutionalized persons living with chronic HBV in 2011-2012 Viral
More informationViral Hepatitis: Dr Erana Gray General and Infectious Diseases Physician
Viral Hepatitis: Dr Erana Gray General and Infectious Diseases Physician Outline: Virology HBV + pregnancy HCV + new treatments Cases Hepatitis Foundation HBV: virus HBsAg far in excess of complete virions,
More informationConsensus AASLD-EASL HBV Treatment Endpoint and HBV Cure Definition
Consensus AASLD-EASL HBV Treatment Endpoint and HBV Cure Definition Anna S. Lok, MD, DSc Alice Lohrman Andrews Professor in Hepatology Director of Clinical Hepatology Assistant Dean for Clinical Research
More informationTreatment of chronic hepatitis B 2013 update
22 February 213 Treatment of chronic hepatitis B 213 update Pietro Lampertico 1st Gastroenterology Unit Fondazione IRCCS Cà Granda - Ospedale Maggiore Policlinico Università di Milano EASL 212 Clinical
More informationNatural History of HBV Infection
Natural History of HBV Infection Joseph JY Sung MD PhD Institute of Digestive Disease Department of Medicine & Therapeutics Prince of Wales Hospital The Chinese University of Hong Kong HBV Infection 2
More informationSerum Hepatitis B Surface Antigen Levels Help Predict Disease Progression in Patients With Low Hepatitis B Virus Loads. Hepatology Feb 2013
Serum Hepatitis B Surface Antigen Levels Help Predict Disease Progression in Patients With Low Hepatitis B Virus Loads Hepatology Feb 2013 Hepatitis B Surface Antigen HBsAg is the glycosylated envelope
More informationManagement of Patients with Chronic Hepatitis B: The Alaska Experience
Management of Patients with Chronic Hepatitis B: The Alaska Experience Brian J McMahon, MACP, FAASLD Liver Disease and Hepatitis Program Alaska Native Tribal Health Consortium Disclosures I have no conflicts
More informationClinical Management of Hepatitis B WAN-CHENG CHOW DEPARTMENT OF GASTROENTEROLOGY & HEPATOLOGY SINGAPORE GENERAL HOSPITAL
Clinical Management of Hepatitis B WAN-CHENG CHOW DEPARTMENT OF GASTROENTEROLOGY & HEPATOLOGY SINGAPORE GENERAL HOSPITAL The World Health Organisation recent initiatives on HBV infection Launching of the
More informationHepatitis B Diagnosis and Management. Marion Peters University of California San Francisco
Hepatitis B Diagnosis and Management Marion Peters University of California San Francisco COI Spouse works for Hoffmann-La Roche HBV is a life long, dynamic disease Changes over time Risk of end stage
More informationThe Evolving Landscape of Preventing Maternal-Fetal Hepatitis B Infections
The Evolving Landscape of Preventing Maternal-Fetal Hepatitis B Infections Neil S. Silverman, M.D. Center for Fetal Medicine and Women s Ultrasound Clinical Professor, Obstetrics/Gynecology David Geffen
More informationNew therapeutic strategies in HBV patients
New therapeutic strategies in HBV patients Philippe HALFON MD, PhD Associate Professor of Medecine Internal Medecine and Infectious Diseases, Hopital Europeen, Marseille, France. NUC + PEG IFN, HBsAg Clearance
More informationHepatitis B: Future treatment developments
Hepatitis B: Future treatment developments VIII International Update Workshop in Hepatology Curitiba, 27.08.2016 Christoph Sarrazin St. Josefs-Hospital Wiesbaden and Goethe-University, Frankfurt am Main
More informationPrimary Care for Hepatitis B and C:
Primary Care for Hepatitis B and C: Clinical Tools for Efficient Management Estimated 17 Million Persons With HCV Infection Worldwide 3-4 million newly infected each yr worldwide Advances in Internal Medicine
More informationWorld Health Organization. Western Pacific Region
Standard modules for HBV 1 HBV Module 1 Hepatitis B serological markers and virology 2 Acute hepatitis HAV HBV HCV HDV HEV Case fatality Case fatality Uncommon increases with increases with age age Superinfection
More informationTerapia dell epatite cronica B: paradigmi attuali e possibili scenari futuri
Terapia dell epatite cronica B: paradigmi attuali e possibili scenari futuri Nicola Coppola Dipartimento di Salute Mentale e Medicina Preventiva Seconda Università di Napoli Main goal of treatment of chronic
More informationNH2 N N N O N O O P O O O O O
N N NH 2 N N O O P O O O O O O James Watson and Francis Crick Double Helix 1953 Baruch Blumberg, MD, PhD 1925-2011 Australia Antigen 1965 Hepatitis B Virus (HBV) Hepadnaviridae member that primarily infects
More informationIs there a need for combination therapy? No. Maria Buti Hospital General Universitario Valle Hebron Barcelona. Spain
Is there a need for combination therapy? No Maria Buti Hospital General Universitario Valle Hebron Barcelona. Spain No, No and No EASL Update HBV Guidelines 2012 The most potent drugs with the optimal
More informationA tale of two patients
15 th Annual Resistance and Antiviral Therapy Meeting Dr Sanjay Bhagani Royal Free Hospital, London Thursday 29 September 2011, Royal College of Physicians, London A tale of two patients Sanjay Bhagani
More information27/01/17. Post-partum ALT flare. HBV vaccine cannot protect all babies from high viral load carrier mothers
Trepo, Chan and Lok. Lancet 2014;384:2053-63 Prevalence High (>7%) Intermediate (2%-7%) Low (
More informationHBV/HCV COINFECTIONS IN PATIENTS WITH HIV. Dr Reena Harania MBBS, MRCP, MSc Infectious Disease
HBV/HCV COINFECTIONS IN PATIENTS WITH HIV Dr Reena Harania MBBS, MRCP, MSc Infectious Disease Adults and children estimated to be living with HIV as of end 2005 North America 1.2 million [650 000 1.8 million]
More informationHepatitis B Case Studies
NORTHWEST AIDS EDUCATION AND TRAINING CENTER Hepatitis B Case Studies Nina Kim, MD MSc Associate Professor of Medicine University of Washington Harborview Madison Clinic and Hepatitis & Liver Clinic No
More informationChronic Hepatitis. Andrew Bathgate Chris Bellamy Royal Infirmary of Edinburgh
Chronic Hepatitis Andrew Bathgate Chris Bellamy Royal Infirmary of Edinburgh Autoimmune Hepatitis Annual incidence 1.9/100 000 in N Europe Prevalence 16.9/100 000 ~5% all liver transplants Female preponderance
More informationTreatment of HCC in real life-chinese perspective
Treatment of HCC in real life-chinese perspective George Lau MBBS (HK), MRCP(UK), FHKCP, FHKAM (GI), MD(HK), FRCP (Edin, Lond), FAASLD (US) Chairman Humanity and Health Medical Group, Hong Kong SAR, CHINA
More informationManagement of Hepatitis B
Management of Hepatitis B Background HBV is contracted either sexually or by blood to blood transmission. The combined prevalence of HBV and HCV is just over 2% in the UK. More than 95% of immune competent
More informationcasebasedhepatitis bmanagement Management of Hepatitis B: A Case-based Approach
casebasedhepatitis bmanagement Management of Hepatitis B: A Case-based Approach In order to receive credit for this activity, please complete the post-test by recording the best answer to each question
More informationNeed for long-term evaluation of therapy in Chronic Hepatitis B
Need for long-term evaluation of therapy in Chronic Hepatitis B VHPB meeting Budapest 18/03/2010 Solko Schalm & Mehlika Toy Licensed Therapy Chronic hepatitis B Drug Date of Efficacy Disease Clinical Mortality
More information