Healthy Liver Cirrhosis
|
|
- Brent Gilbert
- 5 years ago
- Views:
Transcription
1 Gioacchino Angarano Clinica delle Malattie Infettive Università degli Studi di Foggia Healthy Liver Cirrhosis Storia naturale dell epatite HCVcorrelata in assenza di terapia Paestum Maggio 24
2 The Natural History of Hepatitis C Infection Difficulties usually asymptomatic onset usually asymptomatic course long disease duration 3-4 yrs often presence of co-factors
3 Clinical Outcomes Acute HCV infection subclinic acute hepatitis
4 Outcome of Acute Hepatitis C Healthy carrier? 1-2%? 5-85% Chronic Hepatitis 15-5% Spontaneous viral clearance
5 Primary HCV Infection c1 NS3 c22 HCV-RNA ALT Anti-HCV (EIA) HCV RNA in serum within 1-2 weeks after exposure Anti-HCV antibodies in serum within 3-2 weeks (average 7) ALT increase after 4-12 weeks Clinical symptoms in 1-3% Fulminant hepatitis is rare weeks years exposure
6 Course of Acute hepatitis C Outcome Spontaneous resolution in about one third of the patients No patients = 4 Median Follow-up = 35 months (range 6-68) 3% Self-limited hepatitis 7% Chronic evolution Santantonio et al Digest Liver Dis 23
7 Studies Demonstrating High Rates of Spontaneous Recovery in HCV Infection Author Country % Recovery Setting Kenny Walsh Wiese Vogt Rodgers Gerlach Ireland Germany Germany Australia Germany Contaminated Rh Ig Contaminated Rh Ig TAH* - children Community acquired Symptomatic disease
8 Acute Hepatitis C Factors that may influence the evolution Virus Quasispecies evolution Gender Host Age at onset Source of infection Immunocompetence Genetic profile Symptomatic disease
9 Natural Course of Acute hepatitis C Prognostic factors icteric AHC Jaundice significantly associated with selflimited hepatitis 55% Chronicity 45% Resolution No correlation with: Genotype, Viral load at presentation, Sex, Mode of trasmission anicteric AHC 15% Resolution 85% Chronicity Santantonio et al Digest Liver Dis 23
10 Clinical Outcomes Acute HCV infection subclinic acute hepatitis ~3% ~7% Complete Recovery Chronic HCV hepatitis
11 Strategies for determining Natural History of Chronic hepatitis Initial infection Early phase Chronic hepatitis Late phase chronic Hepatitis (cirrhosis) 2 to 4 years Retrospective Studies Prospective Studies Retrospective prospective (non concurrent) cohort studies
12 Long- Term outcome of HCV infection Retrospective Studies Author Country Pts Interval from Cirrhosis HCC Liver exposure (yrs) (%) (%) Death (%) Kiyosawa Japan NR Tong USA Yano Niederau Japan Germany NR^ mean 42% NR 2. NR 3.7 Gordon* Usa NR Gordon** Usa NR * Transfusion ; ** Community Acquired; ^ Not reported
13 Long- Term outcome of HCV infection Prospective Studies Author Country Pts Interval from Cirrhosis HCC Liver exposure (yrs) (%) (%) Death (%) Di Bisceglie USA Koretz Mattson USA Sweden mean 11% 1.3 NR Tremolada Italy
14 Long- Term outcome of HCV infection Retrospective Prospective Studies Author Group Pts Interval from Cirrhosis HCC Liver exposure (yrs) (%) (%) Death (%) Vogt Children Kenny-Walsh Young women Wiese Seeff* Young women Young men <6% Thomas IDU Rodgers Comm acq Seeff** PTH *Community-acquired **Transfusion
15 Progression to cirrhosis after 2-year HCV infection by study recruitment % (11-37%) 22% (18-26%) 57 studies % (4-1%) 4% (1-7%) Post-transfusion hepatitis (5) Liver Clinics (33) Community-based cohorts (9) Blood Donors (1) Mean age Freeman et al Hepatology 21
16 PROGRESSION OF HEPATIC FIBROSIS IN CHRONIC HEPATITIS C 4 Men > 4 yr Alcohol > 5 gr/die Fibrosis Rapid Medium Slow Women < 4 yr Alcohol < 5 gr/die Years Poynard et al Lancet 1997;349:
17 Potential Cofactors As Determinants of Disease Progression Viral factors Host Factors External Factors Viral Load Viral Genotype Multiplicity of quasispecies Age at infection Gender Duration of infection Disease expression Immune deficiency Genetic susceptibility Coinfections (HIV, HBV) Co-morbid conditions e.g., hemochromatosis, non alcoholic steatohepatitis, Alcohol abuse Diet Smoking Drugs Hepatotoxins Environmental contaminants
18 HCV: natural history Alcohol Increased risk of cirrhosis in HCV-infected patients who drink 3-6g alcohol per day Sustained virological response to IFN is lower in patients with a recent history of alcohol abuse Increased quasispecies and viremia levels in alcoholics Alcohol and HCV are sinergistic in accelerating hepatic fibrosis in patients through immune related reactions and increased oxidative stress Morgan et al Alcohol Clin Exp Res 23
19 HCV: natural history HBV coinfection: More severe liver damage More rapid clinical course High risk for HCC Lower IFN therapy response
20 Liver histopathology in patients with hepatitis B/C and hepatitis B/C/D compared with matched control subjects with HCV alone Total Scheuer score Hepatitis C (n=24) Hepatitis C (n=24) p = <.1 Hepatitis B+C (n=12) Hepatitis B+C+D (n=12) Weltman et al J Viral Hepat 1995
21 Risk for HCC according to Alcohol Intake and the Presence of HCV and HBV Infection Alcohol intake (g/day) -6 > 6 Cases/Controls (no.) O.R. Cases/Controls (no.) O.R. Neither 3/ / HCV infection 95/ / HBV infection 41/ / Donato et al., Am J Epidemiol 22
22 Rates of HCC in Relation to Etiology of Cirrhosis Cumulative probability of HCC (%) HBsAg+/anti-HCV+ p =.2 Alcohol abuse Anti-HCV pos HBsAg pos All negative Months Benvegnù et al,. Cancer 1994
23 Occult HBV infection in patients with chronic hepatitis C Pts = 2 HCV positive Anti-HBc positive Anti-HBc negative Histologic findings Minimal changes Chronic hepatitis Cirrhosis Liver HBV DNA Positive N=66 (33%) 46 2 Negative N=134 5 (4%) 44 (67%) 13 (77%) 22 (33%) 26 (19%) p ns ns.4 Occult HBV infection may interfere with the clinical outcome of chronic hepatitis C and favor or accelerate the evolution to cirrhosis Cacciola et al N Engl J Med 1999
24 Fibrosis Grade (METAVIR) Liver Fibrosis Progression: Influence of HIV Coinfection HIV positive (n = 122) HIV negative (n = 122) Duration of HCV Infection (yr) Patients matched for sex, risk factors, age,age at HCV contamination, age at liver biopsy and daily alcohol consumption. Benhamou Y, et al. Hepatology. 1999;3:154.
25 Increased Risk of Cirrhosis and ESLD in HIV/HCV-Coinfected Patients. META-ANALYSIS Graham CS Clin Infect Dis. 21
26 F F1 F2 F3 F4 4-6 anni 1-15 anni 1-15 anni 4-6 anni Coinfezione HIV-HCV CD4 < 5 5 anni
27 Liver histology among 159 HCV carriers with persistently normal ALT* (Italian prospective study of the asymptomatic C carriers) Minimal CH 34% Mild CH 44% Normal 17% Cirrhosis Mod/severe 4% 1% * (ALT every 3 months over a 12-month period) Puoti et al J Hepatol 22
28 Predictive Value of ALT Levels for Histologic Findings in Chronic Hepatitis C: a European Collaborative Study METAVIR Fibrosis Score Normal ALT Elevated ALT 35% 2% 52% 12% 1% 24% 51% 17% 8% = no fibrosis, 1= portal fibrosis without septa, 2= portal fibrosis with few septa, 3= septal fibrosis without cirrhosis, 4= cirrhosis Pradat et al Hepatology 22
29 Natural history of HCV carriers with persistently normal ALT Prospective studies with histological follow-up Persico et al Gastroenterology 2 Martinot-Peignoux et al Hepatology 21 Very slow or no fibrosis progression
30 Chronic Hepatitis C: Progression to Cirrhosis Baseline Fibrosis 1% 8% Cirrhosis 6% 4% Severe Moderate Mild 2% Years Adapted from Yano M et al. Hepatology. 1996;23:1336.
31 Survival in compensated cirrhosis C Reference Area Pts (n) Median age (yrs) Median follow-up (yrs) 5-year survival Niederau 1998 Germany Hu 1999 U.S.A Degos 2 France Eurohep 22 Europe % 8 survival decompensation HCC years Eurohep, Am J Gastroenterol 22; 97:
32 Compensated cirrhosis type C independent factors affecting survival multivariate analysis (Cox s model) Factors prognosis worse if p value age gender albumin bilirubin platelets oesophageal varices older male < 35 g/l > µmol/l < 13 x 1 9 /l present Fattovich et al Gastroenterology 1997; 112: Degos et al Gut 2; 47:
33 Development of decompensation in HCV-related cirrhosis (ascites, jaundice, encephalopathy, variceal bleeding) Reference Area patients Child's Mean Incidence 4 to 5 yrs (no.) grade follow-up 1 risk (%) (yrs) person/yrs 1. Eurohep Europe 136 A Serfaty France 13 A/B Hu U.S.A. 112 A/B Am J Gastroenterol 22; 97: Hepatology 1998; 27: Hepatology 1999; 29:
34 Incidence of HCC in HCV-related Cirrhosis Authors Country 3 yrs 5 yrs 1 yrs Fattovich 1997 Europe 3% 7% 14% Chiaramonte 1999 Italy 7% 2% 28% Benvegnù 1994 Italy 2.8% 11.5% 3% Ikeda 1993 Japan 1% 21% 53% Yoshida 1999 Japan 12.5% 2% 6%
35 Clinical Outcomes Year Acute HCV infection subclinic acute hepatitis Increasing Fibrosis ~ 3% Complete Recovery ~2% Cirrhosis ~ 7% Chronic HCV hepatitis ~8% Asymptomatic Year 3 4-5% / yr Decompensated cirrhosis Hepatocellular Carcinoma 1-5% / yr
Viral 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 informationUpdate on HIV-HCV Epidemiology and Natural History
Update on HIV-HCV Epidemiology and Natural History Jennifer Price, MD Assistant Clinical Professor of Medicine University of California, San Francisco Learning Objectives Upon completion of this presentation,
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 informationSteatosi epatica ed HCV
Steatosi epatica ed HCV Malattie delle vie biliari ed Epatologia Rho, Auditorium Padri Oblati, 11 Novembre 2006 Piero L. Almasio Università di Palermo HISTOPATHOLOGY Steatosis and accelerated fibrogenesis:
More informationThe Effect of Antiviral Therapy on Liver Fibrosis in CHC. Jidong Jia Beijing Friendship Hospital, Capital Medical University
The Effect of Antiviral Therapy on Liver Fibrosis in CHC Jidong Jia Beijing Friendship Hospital, Capital Medical University 2016-5-29 1 Disclosure Consultation for Abbvie, BMS, Gilead, MSD, Novartis and
More informationCIRROSI E IPERTENSIONE PORTALE NELLA DONNA
Cagliari, 16 settembre 2017 CIRROSI E IPERTENSIONE PORTALE NELLA DONNA Vincenza Calvaruso, MD, PhD Ricercatore di Gastroenterologia Gastroenterologia & Epatologia, Di.Bi.M.I.S. Università degli Studi di
More informationAppendix Table A Frequency of end-stage liver disease in inception cohort. Reference Exposure followup Frequency ESLD (%) Seeff-1 PTH 24 23/568 (4%) 7
Published as supplied by the author Appendix Table A Frequency of end-stage liver disease in inception cohort studies Route of Years Reference Exposure followup Frequency ESLD (%) Locasciulli PTH 1 15
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 informationANTIVIRAL THERAPY FOR HCV. Alfredo Alberti
CLINICAL IMPACT OF SVR AFTER ANTIVIRAL THERAPY FOR HCV Alfredo Alberti Department of Histology,Microbiology and Medical Biotechnologies Molecular Hepatology Unit Venetian Institute of Molecular Medicine
More informationHCV care after cure. This program is supported by educational grants from
HCV care after cure This program is supported by educational grants from Raffaele Bruno,MD Department of Infectious Diseases, Hepatology Outpatients Unit University of Pavia Fondazione IRCCS Policlinico
More informationModule 1 Introduction of hepatitis
Module 1 Introduction of hepatitis 1 Training Objectives At the end of the module, trainees will be able to ; Demonstrate improved knowledge of the global epidemiology of the viral hepatitis Understand
More informationPrise en charge actuelle de l'hépatite C et nouvelles approches thérapeutiques
Prise en charge actuelle de l'hépatite C et nouvelles approches thérapeutiques Future Complications of Darius Moradpour Service de Gastro-entérologie et d'hépatologie Centre Hospitalier Universitaire Vaudois
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 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 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 informationLiver stiffness predicts liver related events and mortality in HIV/HCV coinfected patients
Liver stiffness predicts liver related events and mortality in HIV/HCV coinfected patients José Vicente Fernández-Montero, Pablo Barreiro, Eugenia Vispo, Pablo Labarga, Francisco Blanco, Fernanda Rick,
More informationEnd Stage Liver Disease & Disease Specific Indications for Liver Transplant. Susan Kang, RN, MSN, ANP-BC
End Stage Liver Disease & Disease Specific Indications for Liver Transplant Susan Kang, RN, MSN, ANP-BC Introduction (https://www.srtr.org) What does the liver do? STORAGE METABOLIC DETOXIFICATION SYNTHETIC
More informationEnd Stage Liver Disease & Disease Specific Indications for Liver Transplant Susan Kang, RN, MSN, ANP BC
End Stage Liver Disease & Disease Specific Indications for Liver Transplant Susan Kang, RN, MSN, ANP BC Introduction (https://www.srtr.org) 1 What does the liver do? STORAGE METABOLIC DETOXIFICATION SYNTHETIC
More informationAssessing the patient with a new diagnosis of Hepatitis C LAUREN MYERS MMSC, PA-C OREGON HEALTH & SCIENCE UNIVERSITY
Assessing the patient with a new diagnosis of Hepatitis C LAUREN MYERS MMSC, PA-C OREGON HEALTH & SCIENCE UNIVERSITY Disclosures Nothing to Disclose Assessing the patient with a new diagnosis of Hepatitis
More informationNIH Consensus Conference Statement. Management of Hepatitis C. March 24-26, NIH Web site. Available at:
ABC s of Hepatitis C Treatment Today Elizabeth N. Britton, MSN, FNP-BC Hepatology Services Louisiana State University Health Sciences Center ebritt@lsuhsc.edu ANAC CONFERENCE -TUCSON NOV 2012 Hepatitis
More informationDISCLOSURES. This activity is jointly provided by Northwest Portland Area Indian Health Board and Cardea
DISCLOSURES This activity is jointly provided by Northwest Portland Area Indian Health Board and Cardea Cardea Services is approved as a provider of continuing nursing education by Montana Nurses Association,
More informationHepatology For The Nonhepatologist
Hepatology For The Nonhepatologist Andrew Aronsohn, MD Associate Professor of Medicine University of Chicago Chicago, Illinois Learning Objectives After attending this presentation, learners will be able
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 informationHepatitis C Virus (HCV)
Clinical Practice Guidelines Hepatitis C Virus (HCV) OBJECTIVE The purpose is to guide the appropriate diagnosis and management of Hepatitis C Virus (HCV). GUIDELINE These are only guidelines, and are
More informationChanging epidemiology of HCC in Italy
Changing epidemiology of HCC in Italy G. Svegliati-Baroni Clinica di Gastroenterologia SOS Epatopatie Croniche-Trapianto di Fegato Università Politecnica delle Marche, Ancona Worldwide estimated new PLC
More information4 Natural History of Hepatitis C
4 Natural History of Hepatitis C Gregory T. Everson, MD CONTENTS INTRODUCTION PREVALENCE, RISK FACTORS, AND INCIDENCE ACUTE HEPATITIS C FULMINANT HEPATITIS C CHRONIC INFECTION AND SEQUELAE CHRONIC INFECTION
More informationProfessor Norbert Bräu
Sixth Annual BHIVA Conference for the Management of HIV/Hepatitis Co-Infection in collaboration with BASL and BVHG Professor Norbert Bräu James J Peters VA Medical Center, New York, USA COMPETING INTEREST
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 informationHepatitis C. Core slides
Hepatitis C Core slides This material was prepared by the Viral Hepatitis Prevention Board The slides (or subsets) can be reproduced for educational use only, with reference to the original source and
More informationRisk Factors and Preventive Measures for Hepatocellular carcinoma (HCC) 울산의대울산대병원소화기내과박능화
Risk Factors and Preventive Measures for Hepatocellular carcinoma (HCC) 울산의대울산대병원소화기내과박능화 Risk factors for HCC development (I) Environmental factors Infectious HBV HCV HDV Alimentary Alcohol Diet High
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 informationEvaluating HIV Patient for Liver Transplantation. Marion G. Peters, MD Professor of Medicine University of California San Francisco USA
Evaluating HIV Patient for Liver Transplantation Marion G. Peters, MD Professor of Medicine University of California San Francisco USA Slide 2 ESLD and HIV Liver disease has become a major cause of death
More informationHepatitis C Update on New Treatments
Hepatitis C Update on New Treatments Kevork M. Peltekian, MD, FRCPC 44th Annual Dalhousie Spring Refresher Course - Therapeutics April 5 - April 7, 2018 Halifax Convention Centre Disclosures Conflicts
More informationInfective hepatic complications in HSCT patients. Simone Cesaro. Pediatric Hematology Oncology Verona, Italy. Session II: organ specific complications
Session II: organ specific complications Infective hepatic complications in HSCT patients Simone Cesaro Pediatric Hematology Oncology Verona, Italy simone.cesaro@ospedaleuniverona.it Liver complications
More informationLong-term Clinical Outcomes and Risk of Hepatocellular Carcinoma in Chronic Hepatitis B Patients with HBsAg Seroclearance
Long-term Clinical Outcomes and Risk of Hepatocellular Carcinoma in Chronic Hepatitis B Patients with HBsAg Seroclearance Gi-Ae Kim, Han Chu Lee *, Danbi Lee, Ju Hyun Shim, Kang Mo Kim, Young-Suk Lim,
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 informationMeet the Professor: HIV/HCV Coinfection
Meet the Professor: HIV/HCV Coinfection Vincent Lo Re, MD, MSCE Assistant Professor of Medicine and Epidemiology Division of Infectious Diseases Center for Clinical Epidemiology and Biostatistics University
More informationLa gestione corrente dell infezione cronica da HCV: la progressione verso la cirrosi. Simona Landonio I Div Mal inf H Sacco Milano
La gestione corrente dell infezione cronica da HCV: la progressione verso la cirrosi Simona Landonio I Div Mal inf H Sacco Milano HCV Natural History Viganò M et al Gastroenterology 27;133:835-842 Overall
More informationEpidemiology and Screening for Hepatitis C Infection
Epidemiology and Screening for Hepatitis C Infection Atif Zaman, MD MPH Oregon Health & Science University Professor of Medicine Division of Gastroenterology and Hepatology Epidemiology/Screening for Hepatitis
More informationHepatitis C Management and Treatment
Hepatitis C Management and Treatment Kaya Süer Near East University Faculty of Medicine Infectious Diseases and Clinical Microbiology 1 Discovery of Hepatitis C Key facts Hepatitis C: the virus can cause
More informationDIFFERENTIAL BENEFITS OF DAAs IN DIFFERENT PATIENT POPULATIONS. IN PATIENTS ON A WAITING LIST FOR TRANSPLANTATION. THE CLINIC.
DIFFERENTIAL BENEFITS OF DAAs IN DIFFERENT PATIENT POPULATIONS. IN PATIENTS ON A WAITING LIST FOR TRANSPLANTATION. THE CLINIC. Robert J. de Knegt, Erasmus MC, Rotterdam r.deknegt@erasmusmc.nl Disclosures
More information3 Workshop on HCV THERAPY ADVANCES New Antivirals in Clinical Practice
3 Workshop on HCV THERAPY ADVANCES New Antivirals in Clinical Practice Rome, 13 December 2013 Management and monitoring of HCC in the future era of DAA s Prof. Massimo Colombo Chairman Department of Liver,
More informationWorldwide Causes of HCC
Approach to HCV Treatment in Patients with HCC JORGE L. HERRERA, MD, MACG UNIVERSITY OF SOUTH ALABAMA COLLEGE OF MEDICINE Worldwide Causes of HCC 60% 50% 40% 54% 30% 20% 10% 31% 15% 0% Hepatitis B Hepatitis
More informationHepatitis Alert: Management of Patients With HCV Who Have Achieved SVR
Hepatitis Alert: Management of Patients With HCV Who Have Achieved SVR This program is supported by educational grants from AbbVie, Gilead Sciences, and Merck About These Slides Please feel free to use,
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 informationDelta hepatitis: How to manage and optimize therapy? Dominique ROULOT Unité d Hépatologie, Hôpital Avicenne
Delta hepatitis: How to manage and optimize therapy? Dominique ROULOT Unité d Hépatologie, Hôpital Avicenne Delta hepatitis treatment in 2018 Currently, Peg-IFNα 180 µg/wk is the only effective treatment
More informationBible Class: Hepatitis B Virus Infection
Bible Class: Hepatitis B Virus Infection Nasser Semmo UVCM, Hepatology What is the HBV prevalence? 2 Hepatitis B Worldwide approx. 350 Mio. chronically infected with HBV Approx. 40% of the world population:
More informationPrograms for Chronic HBV and HCV in Alaska Natives
Programs for Chronic HBV and HCV in Alaska Natives Brian J McMahon MD, Liver Disease and Hepatitis Program Alaska Native Medical Center and Arctic Investigations Program, CDC Misconceptions about Alaska
More informationDetection and significance of PD-1.3 SNP (rs ) and IL28B SNP (rs ) in patients with current or past hepatitis B virus (HBV) infection
Detection and significance of PD-1.3 SNP (rs11568821) and IL28B SNP (rs12979860) in patients with current or past hepatitis B virus (HBV) infection Asterios Saitis 1, Nikolaos K. Gatselis 1, Kalliopi Azariadi
More informationThe Long Term Care Risk
Hepatitis C The Long Term Care Risk Objectives Basics of the disease Disease progression Comorbid factors Treatment Long term care risk Basics of Hepatitis C Caused by an RNA virus Clinical Course Acute
More informationAre we adequately screening at-risk patients for hepatocellular carcinoma in the outpatient setting?
Rajani Sharma, PGY1 Geriatrics CRC Project, 12/19/13 Are we adequately screening at-risk patients for hepatocellular carcinoma in the outpatient setting? A. Study Purpose and Rationale Hepatocellular carcinoma
More informationWhite Nights of Hepatology 2016
White Nights of Hepatology 2016 Saint Petersburg, 3 June 2016 Long-term treatment of Chronic hepatitis B - a key to HCC prevention Massimo Colombo Chairman Department of Liver, Kidney, Lung and Bone Marrow
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 informationHIV coinfection and HCC
HIV coinfection and HCC 3 rd APASL STC on HCC 21 st -23 rd Nov 2013 Cebu, Phillippines George KK Lau MBBS (HK), MRCP(UK), FHKCP, FHKAM (GI), MD(HK), FRCP (Edin, Lond) Consultant, Humanity and Health GI
More informationFollow-up of patients with SVR Lawrence Serfaty Service d Hépatologie, UMR_S 938 Hôpital Saint-Antoine Université Pierre&Marie Curie Paris, France
9th Paris Hepatitis Conference, January 11-12, 2016 Follow-up of patients with SVR Lawrence Serfaty Service d Hépatologie, UMR_S 938 Hôpital Saint-Antoine Université Pierre&Marie Curie Paris, France Disclosures
More informationHepatology for the Nonhepatologist
Hepatology for the Nonhepatologist Kenneth E. Sherman, MD, PhD Gould Professor of Medicine Director, Division of Digestive Diseases University of Cincinnati College of Medicine Cincinnati, Ohio Learning
More informationViral hepatitis. Supervised by: Dr.Gaith. presented by: Shaima a & Anas & Ala a
Viral hepatitis Supervised by: Dr.Gaith presented by: Shaima a & Anas & Ala a Etiology Common: Hepatitis A Hepatitis B Hepatitis C Hepatitis D Hepatitis E Less common: Cytomegalovirus EBV Rare: Herpes
More informationDuring the course of chronic hepatitis B virus. Long-Term Outcome After Spontaneous HBeAg Seroconversion in Patients With Chronic Hepatitis B
Long-Term Outcome After Spontaneous HBeAg Seroconversion in Patients With Chronic Hepatitis B Yao-Shih Hsu, 1 Rong-Nan Chien, 1 Chau-Ting Yeh, 1 I-Shyan Sheen, 1 Hung-Yi Chiou, 2 Chia-Ming Chu, 1 and Yun-Fan
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. Dr. Mohamed. A. Mahdi 5/2/2019. Mob:
Hepatitis Dr. Mohamed. A. Mahdi Mob: 0123002800 5/2/2019 Hepatitis Hepatitis means the inflammation of the liver. May cause by viruses or bacteria, parasites, radiation, drugs, chemical and toxins (alcohol).
More informationLearning Objectives. After attending this presentation, participants will be able to:
Learning Objectives After attending this presentation, participants will be able to: Describe HCV in 2015 Describe how to diagnose advanced liver disease and cirrhosis Identify the clinical presentation
More informationB C Outlines. Child-Pugh scores
B C 2016-12-09 Outlines Child-Pugh scores CT MRI Fibroscan / ARFI Histologic Scoring Systems for Fibrosis Fibrosis METAVIR Ishak None 0 0 Portal fibrosis (some) 1 1 Portal fibrosis (most) 1 2 Bridging
More informationLa storia clinica del paziente con infezione cronica da HCV: focus epidemiologico. Monica Schiavini
La storia clinica del paziente con infezione cronica da HCV: focus epidemiologico Monica Schiavini 105/185 million people anti-hcv positive worldwide Global anti HCV prevalence in adults: 2% 3/4 million
More informationUses and Misuses of Viral Hepatitis Testing. Origins of Liver Science
Uses and Misuses of Viral Hepatitis Testing Richard S Lang, MD, MPH, FACP Chairman, Preventive Medicine Vice-Chair, Wellness Institute Raul J Seballos, MD, FACP Vice-Chair, Preventive Medicine Wellness
More informationHepatitis B in Africa: Epidemiology, Pathophysiology and Challenges
Gilead-sponsored symposium at the 11th INTEREST Workshop 2017 Hepatitis B in Africa: Epidemiology, Pathophysiology and Challenges Ponsiano Ocama Department of Medicine Makerere University College of Health
More informationRelative predictive factors for hepatocellular carcinoma after HBeAg seroconversion in HBV infection
PO Box 2345, Beijing 123, China World J Gastroenterol 25;11(43):6848-6852 www.wjgnet.com World Journal of Gastroenterology ISSN 17-9327 wjg@wjgnet.com E L S E V I E R 25 The WJG Press and Elsevier Inc.
More informationThe ABCs of Viral Hepatitis Diagnosis. Ila Singh, M.D., Ph.D. P & S Viral Hepatitis. Hepatitis A, B, C, D, E and G viruses
The ABCs of Viral Hepatitis Diagnosis Ila Singh, M.D., Ph.D. P & S 14-453 is132@columbia.edu Viral Hepatitis Hepatotropic viruses Hepatitis A, B, C, D, E and G viruses Generalized infection plus infection
More informationShould Elderly CHC Patients (>70 years old) be Treated?
Should Elderly CHC Patients (>70 years old) be Treated? Deepak Amarapurkar Consultant Gastroenterologist & Hepatologist Bombay Hospital & Medical Research Center, Mumbai & Jagjivanram Western Railway Hospital,
More informationHCV Viremia Was Associated With Increased Mortality in a Prospective Taiwanese Cohort Study
Tram T. Tran, MD, FACG Approach to HCV Treatment in Patients with HCC Tram T. Tran, MD, FACG Professor of Medicine Medical Director, Liver Transplant Cedars Sinai Medical Center Natural History of HCV
More informationNon-Invasive Testing for Liver Fibrosis
NORTHWEST AIDS EDUCATION AND TRAINING CENTER Non-Invasive Testing for Liver Fibrosis John Scott, MD, MSc Associate Professor, University of Washington Associate Clinic Director, Hep/Liver Clinic, Harborview
More informationHCV in the Latino Community -Epidemiology, Natural History, Risk Factors, Screening and Diagnosis
HCV in the Latino Community -Epidemiology, Natural History, Risk Factors, Screening and Diagnosis Wari Allison MD, PhD Assistant Professor/Research Dept. of Medicine/Infectious Disease Medical Director
More informationManagement of Hepatitis C in Primary Care BABAFEMI ONABANJO, MD & BEN ALFRED, FNP UMASS FAMILY HEALTH CENTER WORCESTER
Management of Hepatitis C in Primary Care BABAFEMI ONABANJO, MD & BEN ALFRED, FNP UMASS FAMILY HEALTH CENTER WORCESTER Objective Epidemiology Screening criteria Appropriate work up Treatment Guidelines
More informationHepatitis and pregnancy
Hepatitis and pregnancy Pierre-Jean Malè MD Training Course in Reproductive Health Research WHO Geneva 2008 26.02.2008 Liver disease and pregnancy: three possible etiologic relationship the patient has
More informationLiver disease in 2017: challenges and opportunities
Liver disease in 2017: challenges and opportunities Dr Matthew Cowan Consultant Gastroenterologist and Hepatologist Surrey and Sussex Healthcare NHS Trust Faculty of Physician Associates 2 nd National
More informationHCC Prevention. Jee-Fu Huang. Kaohsiung Municipal Hsiao-Kang Hospital, KMUH Kaohsiung (Takao), Taiwan. TCC, HCC Prevention, 26 Nov, 2011
HCC Prevention Jee-Fu Huang Kaohsiung Municipal Hsiao-Kang Hospital, KMUH Kaohsiung (Takao), Taiwan TCC, HCC Prevention, 26 Nov, 2011 1 Outline Pathogenic and Risk Factors HBV HCV Primary Secondary Primary
More informationInitial Evaluation for HCV Therapy. Hope McGratty PA-C, MPH
Initial Evaluation for HCV Therapy Hope McGratty PA-C, MPH Conflict of Interest Disclosure Statement None Who are we talking about today? Treatment naïve Chronic infection This patient seems complicated
More informationAntiviral Therapy 2015; 20:65 72 (doi: /IMP2827)
Antiviral Therapy 2015; 20:65 72 (doi: 10.3851/IMP2827) Original article Long-term survival and liver-related events after pegylated interferon/ribavirin therapy in HIV infected patients with chronic hepatitis
More informationNew York State HCV Provider Webinar Series. Side Effects of Therapy
New York State HCV Provider Webinar Series Side Effects of Therapy Objectives Understand the basics of HCV therapy Review the currently available regimens for treatment of HCV Appreciate side effects related
More informationLiver Transplantation: The End of the Road in Chronic Hepatitis C Infection
University of Massachusetts Medical School escholarship@umms UMass Center for Clinical and Translational Science Research Retreat 2012 UMass Center for Clinical and Translational Science Research Retreat
More informationHepatocellular Carcinoma in HIV-infected Patients A Growing Complication of Coinfection with HCV or HBV Mon, 31 May 2010
Bronx VA Medical Center Mount Sinai School of Medicine Hepatocellular Carcinoma in HIV-infected Patients A Growing Complication of Coinfection with HCV or HBV Mon, 31 May 2010 Norbert Bräu, MD, MBA Associate
More informationNatural history and prognostic factors for chronic hepatitis type B
294 Gut, 1991, 32, 294-298 LIVER, BILIARY, AND PANCREAS Istituto di Medicina Clinica, Clinica Medica 2, Universita di Padova, Italy G Fattovich L Brollo G Giustina F Noventa P Pontisso A Alberti A Ruol
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 D. Challenges in 2018
Hepatitis D Challenges in 2018 Heiner Wedemeyer Essen University Hospital, Germany Germany Disclosures Honoraria for consulting or speaking (last 5 years): Abbott, AbbVie, Abivax, BMS, Boehringer Ingelheim,
More informationNATURAL HISTORY OF HEPATITIS B
NATURAL HISTORY OF HEPATITIS B AND DIAGNOSTIC: STATE OF THE ART O. BAHRI LABORATORY OF MEDICAL BIOLOGY AZIZA OTHMANA HOSPITAL TUNIS, TUNISIA The 2 nd Congress of The Federation of Arab Societies of Clinical
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 informationLiver Disease. By: Michael Martins
Liver Disease By: Michael Martins Recently I have been getting a flurry of patients that have some serious liver complications. This week s literature review will be the dental management of the patients
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 informationWorldwide Causes of HCC
Approach to HCV Treatment in Patients with HCC Mark W. Russo, MD, MPH, FACG Carolinas HealthCare System Charlotte Worldwide Causes of HCC 60% 50% 40% 30% 20% 10% 0% 54% 31% 15% Hepatitis B Hepatitis C
More informationORAL MANIFESTATIONS IN LIVER DISEASES
ORAL MANIFESTATIONS IN LIVER DISEASES Rodica Ghiuru, D.Munteanu Department of Internal Medicine Abstract: Chronic hepatitis C infection is a worldwide health problem because it causes chronic hepatitis,
More informationAri Bunim, M.D. Director of Hepatology New York Hospital Queens Assistant Professor of Clinical Medicine Weill Cornell Medical College
Ari Bunim, M.D. Director of Hepatology New York Hospital Queens Assistant Professor of Clinical Medicine Weill Cornell Medical College New York State Law Goes into Effect January 1, 2014 Hepatitis C Virus
More informationDevelopment of Hepatocellular Carcinoma After Seroclearance of Hepatitis B Surface Antigen
CLINICAL GASTROENTEROLOGY AND HEPATOLOGY 2009;7:889 893 Development of Hepatocellular Carcinoma After Seroclearance of Hepatitis B Surface Antigen MYRON JOHN TONG,*, MICHAEL ONG NGUYEN, LORI TERESE TONG,
More information47 th Annual Meeting AISF
47 th Annual Meeting AISF Rome, 21 February 2014 Present and future treatment strategies for patients with HCV infection: chronic hepatitis and special populations (HCV/HIV coinfection, advanced cirrhosis,
More informationThe impact of the treatment of HCV in developing Hepatocellular Carcinoma
The impact of the treatment of HCV in developing Hepatocellular Carcinoma Paul Y Kwo, MD Professor of Medicine Medical Director, Liver Transplantation Gastroenterology/Hepatology Division Indiana University
More informationLifetime risk of infection >60% Early childhood infections common
Hepatitis Community Medicine HBV Public health sig HBV is 100 times more infectious than HIV. >350 million chronically infected worldwide. >1 million people die annually of HBV- related chronic liver disease.
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 informationWhy to biopsy? Indications for liver biopsy in common medical liver diseases- how are they changing?
Why to biopsy? Indications for liver biopsy in common medical liver diseases- how are they changing? Stephen D Ryder Nottingham University Hospitals NHS Trust and Biomedical research Unit What are we currently
More informationViral Hepatitis. Dr. Abdulwahhab S. Abdullah CABM, FICMS-G&H PROF. DR. SABEHA ALBAYATI CABM,FRCP
Viral Hepatitis Dr. Abdulwahhab S. Abdullah CABM, FICMS-G&H PROF. DR. SABEHA ALBAYATI CABM,FRCP Viral hepatitis Viral hepatitis must be considered in any patient presenting with hepatitis on LFTs (high
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 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 information