Pretreatment assessment of Chronic Hepatitis C and Compensated Cirrhosis and Indications for Therapy
|
|
- Edgar Payne
- 5 years ago
- Views:
Transcription
1 Pretreatment assessment of Chronic Hepatitis C and Compensated Cirrhosis and Indications for Therapy Teerha Piratvisuth MD. Prince of Songkla University
2 Treatment of chronic hepatitis C and response rates Sustained Virologic Response % NGI <100 copies/ml 16% 33% IFN-2b 24 wk IFN-2b 48 wk IFN-2b + Riba 24 wk 41% IFN-2b + Riba 48 wk McHutchison J. N Engl Med
3 Although all patients with chronic hepatitis C are potential candidates for antiviral therapy, careful pretreatment assessment and selection are mandatory to optimize the risk / benefit and cost / benefit ratio of therapy
4 Pretreatment Assessment Determine the activity and stage of the liver disease Evaluate symptoms and QoL modification attributable to hepatitis C Identify extrahepatic disease Virological assessment : Genotype : Viral load Identify co-morbidities that can influence the treatment decision Identify contraindication to either Interferon or Ribavirin Assess the motivation of the patients
5 Determine Activity and Stage of the Liver Disease Invasive : Liver Biopsy Non-invasive
6 Liver Biopsy remains the gold standard for assessing liver disease in patients with chronic hepatitis C Afdhal NH. et al. Am J Gastroenterol. 2004; 44:
7 Liver Biopsy in Chronic Viral Hepatitis Benefits Risks Patient s consent Physician s skill Contraindications
8 Risk of Complications of Liver Biopsy 30% 30% Pain 0.3% 0.03% Severe Death complication Piccinino F. et al. J Hepatol. 1986;2: Poynard T. et al. Semin Liver Dis 2000;20:47-55
9 Pain after Liver Biopsy 40 % 40% % 10 0 Pain extended beyond the day of the biopsy Would not agree to have biopsy if they know how they would feel during and after the procedure Garcia G. et al. Am J Gastroenterology. 2001;96:
10 Potential Limitations of Liver Biopsy 100 % % Sampling error (multiple biopsies) 15-30% Underestimate of cirrhosis 60-90%* Agreement for the stage of fibrosis * Less agreement for the grade of inflammation Fontana RJ. et al. Hepatology 2002;36:S57-S64 Dienstag JL. et al. Hepatology 2002;36:S152-S160
11 Liver Biopsy in 535 Patients with Chronic Viral Hepatitis 100 % % Additional diagnosis 60% 64% Knowledge of grade and stage were considered of value 81% Treatment was not changed Andriulli A. et al. Dig Dis Sci 2001;46:
12 Noninvasive methods and markers proposed for assessment of liver fibrosis Aspartate aminotransferase (AST) to alanine aminotransferase (ALT) ratio AST to platelet ratio (APRI) Forns fibrosis index Fibro Test Glycocirrhotest Hyaluronan Metalloproteinase Procollagen III European Liver Fibrosis (ELF) index FibroScan
13 AST / ALT Ratio: Diagnosis of Cirrhosis A Study of 252 patients with CH-C AST / ALT ratio > 1 Sensitivity 78% Specificity 97% Combined with platelet < / L Positive predictive values 97% Negative predictive values 86% Giannini E. et al. Arch Intern Med. 2003; 163:
14 AST to Platelet Ratio Index (APRI) APRI = AST level ( /ULN) Platelet count (10/L) 100 Cut-off value < 1.5 Fibrosis Ishak > 3 Cirrhosis PPV 88% 57% NPV 86% 98% Wai CT. et al. Hepatology. 2003; 38(2):
15 Outline of initial reports of each major serum assay for hepatic fibrosis Number of patients Name (serum markers) Significant fibrosis Cutoff Sensitivity Specificity PPV NPV Indirect assays Wai et al APRI (AST, platelets) Forns et al Forns Index (age, GGT, cholesterol, platelet count) Ziol et al FibroScan (hepatic elastography) Imbert-Bismut et al FibroTest (α 2 -macroglobulin, α 2 -globulin, γ- globulin, apolipoprotein A 1, GGT and total bilirubin) Castera et al Combined FibroScan and FibroTest Ishak >3 < % 95% 88% 64% Metavir >2 Metavir >2 Metavir >2 Metavir >2 < % 51% 40% 96% > % 91% 88% 56% % 59% 63% 85% NA NA NA NA
16 Outline of initial reports of each major serum assay for hepatic fibrosis Number of patients Name (serum markers) Significant fibrosis Cutoff Sensitivity Specificity PPV NPV Indirect assays Patel et al FibroSpect (HA, TIMP-1 and α 2 -macroglobulin) Metavir > % 73% 74% 76% Kelleher et al SHASTA (HA, AST and albumin) Rosenberg et al ,021 ELF (Propeptide III collagen, TIMP-1, HA ) Ishak > % 72% 55% 94% Scheuer 3 or % 41% 99% 92%
17 Identify extrahepatic disease HCV and Associated Conditions ESSENTIAL MIXED CRYOGLOBULINEMIA(EMC) GLOMERULONEPHRITIS LICHEN PLANUS SJOGREN S SYNDROME PORPHYRIA CUTANEA TADA (PCT)
18 Evaluate Viral Factors HCV RNA Viral load HCV Genotype Co-infection - HBV -HIV
19 Factors Predictive of Response to PEG IFN/RBV Viral Genotype 2/3 Viral load Baseline <1.3 million IU/mL 12 weeks = 0 or decrease >2 logs Host Fibrosis F0 F1 estimated with Fibrotest BMI <27 Adherence: 80/80/80 Poynard TM, et al. Submitted
20 Peg IFN α-2b monotherapy in CH-C Peg IFN α -2b 1.0 mcg/kg/wk 50 IFN α -2b 3.0 MU TIW 47% 62% Sustained virological response (%) % 21% 14% 6% 8% 2% ALL >2 m. <2 m. 42% 36% 28% 25% ALL >2 m. <2 m. Genotype 1 Genotype 2/3 Trepo C. et al. J Hepatol
21 PEG-IFN SVR in Patients With HCV Genotype 1 SVR (%) n = 101 n = 118 n = 250 n = 271 RBV 800 mg/day PEG-IFN 180 mcg qw RBV 1000/1200 mg/day RBV 800 mg/day 24 Weeks 48 Weeks RBV 1000/1200 mg/day Hadziyannis SJ. EASL Annual Meeting
22 24 weeks PEG-IFN alfa-2b Plus Ribavirin Treatment in HCV Genotypes 2 or 3 SVR % 93% 79% All patients n = 224 Genotype 2 n = 42 Genotype 3 n = 182 Zeuzem S. et al. J Hepatol 2004; 40: 993-9
23 24 weeks PEG-IFN alfa-2b Plus Ribavirin Treatment in HCV Genotypes 2 or 3 SVR % 90.9% 85.9% % Genotype 2 < 600,000 IU/mL n = 20 Genotype 2 > 600,000 IU/mL n = 22 Genotype 3 Genotype 3 < 600,000 IU/mL > 600,000 IU/mL n = 99 n = 83 Zeuzem S. et al. J Hepatol 2004; 40: 993-9
24 Evaluate Host Factors Alcohol drinking BMI Stage of liver disease Iron load Compliance Zeuzem S. et al. Ann Intern Med 2004; 140: Lonardo A. et al. Gastroenterology. 2004; 126: Adinolfi LE. et al. Hepatology. 2001; 33: Fargion S. et al. Am J Gastroenterol. 2002; 97:
25 Probability of developing cirrhosis Marcellin F. et al. Hepatology. Nov 2002; 36(5) Suppl. 1: S47-S56.
26 Progression of fibrosis by duration of infection Marcellin F. et al. Hepatology. Nov 2002; 36(5) Suppl. 1: S47-S56.
27 McHutchison J. Effect of patient compliance on the rate of sustained virological response (>80% of treatment with 1.5 mcg/kg)peg-ifn-alfa-2b + > 10.6 mg/kg Ribavirin All patients 72% HCV Genotype 2, 3 94% HCV Genotype 1 HCV Genotype 1 and > 2million copies/ml. 63% 54% % Sustained virologic response %
28 Contraindications to antiviral therapy Absolute Decompensated (Child B-C) cirrhosis (outside the pretransplant setting) Sever portal hypertension (outside the pretransplant setting) Thrombocytopenia (<50,000) Neutropenia (<1,000) Severe depression Psychosis Seizures Autoimmune disease Pregnancy Uncontrolled diabetes Severe systemic diseases Hypersensitivity to interferon α Relative Thyroid disease Moderate depression Autoimmune markers Alcohol and drug addiction Renal impairment (for peginterferon alfa-2b) Psoriasis
29 Contraindications to antiviral therapy Absolute Relative Anemia (Hb < 10) Anemia (Hb < 12) Pregnancy Hemoglobinopathy End-stage renal failure Severe iron overload Hemolytic anemia Ischemic heart disease Ischemic vascular
30 Indications for anti-hcv Therapy Significant Liver Disease fibrosis > F2 activity > A 2 Significant sympotms: Fatigue Syndrome Extrahepatic diseases
31 Studies that have investigated the effect of antiviral therapy for chronic hepatitis C on health-related quality of life (HRQL) and fatigue Author (ref.) Treatment Study size Additional scales (Significant differences between SVRs and non-svrs) Bonkovsky 1999 Consensus n = 437 Improvement in IFN / IFN-α2b appetite, perception of health and sleep quality Ware 1999 IFN-α2b / ribavirin n = 324 (IFN relapsers) Improvement in HCV-related health distress McHutchison 2001 IFN-α2b / ribavirin n = 912 Improvements in work functioning and productivity
32 Studies that have investigated the effect of antiviral therapy for chronic hepatitis C on health-related quality of life (HRQL) and fatigue Author (ref.) Treatment Study size Additional scales (Significant differences between SVRs and non-svrs) Roudot-Thoraval 2001 Bernstein 2002 PegIFN-α2a / Rasenack 2002 IFN-α2a n = 63 Non-significant trend to improvement in fatigue (VAS) n = 1,441 Improvement in the IFN-α2a FSS PegIFN-α2a / IFNα2a n = 531 Improvement in the FSS Cacoub 2002 Not recorded n = 355 Improvement in fatigue severity onlocal scale Hassanein 2004 PegIFN-α2a / IFNα2a /ribavirin n = 1,221 Improvement in the FSS Wright 2004 IFN-α2b / ribavirin n = 126 (histologically mild disease)
33 Rational for individualized care with Peg-Intron and Rebetol Teerha Piratvisuth MD. Prince of Songkla University
34 Pretreatment assessment and individualized management of hepatitis C virus (HCV) patients Treat without biopsy Biopsy to treat No biopsy No therapy Individualize in clinical practice Young adults No co-factors Easy-to-treat (HCV-2/3) No contraindications Highly motivated Cirrhosis Middle-aged HCV-1 High viral load Co-factors Patient wants to know Doctor wants to know Elderly/children contraindication Long duration with very low ALT
35 PEG-IFN SVR in Patients With HCV Genotype 1 SVR (%) n = 101 n = 118 n = 250 n = 271 RBV 800 mg/day PEG-IFN 180 mcg qw RBV 1000/1200 mg/day RBV 800 mg/day 24 Weeks 48 Weeks RBV 1000/1200 mg/day Hadziyannis SJ. EASL Annual Meeting
36 24 weeks PEG-IFN alfa-2b Plus Ribavirin Treatment in HCV Genotypes 2 or 3 SVR % 90.9% 85.9% % Genotype 2 < 600,000 IU/mL n = 20 Genotype 2 > 600,000 IU/mL n = 22 Genotype 3 Genotype 3 < 600,000 IU/mL > 600,000 IU/mL n = 99 n = 83 Zeuzem S. et al. J Hepatol 2004; 40: 993-9
37 Flat based dosing with IFN α-2b is associated with a decrease in SVR with increasing patient weight IFN-alfa-2b 3 MU TIW 48 weeks % Sustained virologic response 40% 30% 20% 10% 0% 33% <55kg (n=40) 19% 55-75kg (n=300) 13% 75-95kg (n=334) 9% >95kg (n=132) Patient weight McHutchison, JG. N Engl J Med. 1998;339:1485, Poynard T. Lancet. 1998;352:1426.
38 Distribution of patients by body weight Too much drug, increased side effects Appropriate amount of therapy Too little drug, to maximize SVR % of patients all 0 <60kg >60-70kg >70-80kg >80-90kg >90-100kg >100kg Manns, Lancet 2001, Data on file, Schering-Plough Corporation
39 Peg-IFN-alfa-2b + ribavirin Sustained Virologic Response by Weight <65kg 65-85kg >85kg 57% 48% 41% 47% 49% 46% 62% 55% 49% 3MIU + riba ,200mg Peg 0.5 mcg/kg + riba1000-1,200mg Peg 1.5 mcg/kg + riba 800mg Data on file, Schering-Plough Corporation
40 Effect of Ribavirin dose mg/kg on virologic response (Logistic regression analysis) % Sustained virologic response 100% 80% 60% 40% 20% 0% Manns et al., Lancet 2001 Rebetol 10.6 mg/kg 800mg for 75kg PEG 1.5 mcg/kg PEG 0.5 mcg/kg Ribavirin
41 Virologic Relapse Genotype 1 Genotype 2/3 0 % virologic relapse Intron A+Rebetol 1,000-1,200 mg PEG 1.5 +Rebetol 800 mg PEG 1.5 +Rebetol <10.6 mg/kg PEG 1.5 +Rebetol >10.6 mg/kg Data on file Schering-Plough Corporation
42 Sustained Virologic Response Optimal ribavirin Dosing Optimal ribavirin >10.6 mg/kg IFN-alfa-2b 3 MU Peg-IFN-alfa-2b 1.5 Overall 47% 61% Genotype 1 34% 48% Genotype 2/3 81% 88%
43 McHutchison J. Effect of patient compliance on the rate of sustained virological response (>80% of treatment with 1.5 mcg/kg)peg-ifn-alfa-2b + > 10.6 mg/kg Ribavirin All patients 72% HCV Genotype 2, 3 94% HCV Genotype 1 HCV Genotype 1 and > 2million copies/ml. 63% 54% % Sustained virologic response %
44 Rationale for Using Early Viral Response Endpoint Drawbacks of Antiviral Therapy Only half respond Difficult to tolerate Requires close monitoring Expensive Thus, identifying those with the greatest chance of benefiting (or not) from therapy is desirable
45 Early Virological Response HCV RNA negative or > 2 log decrease at 12 weeks (n=380/478 with HCV RNA available; 79%) Yes No SVR (n=273/380; 72%) SVR (n=0/98) NR (n=107/380; 28%) NR (n=98/98; 100%) Davis GL. et al. Hepatology. Sep 2003; 38(3):
46 Cost Benefits of EVR If lack of EVR is used as the basis to stop treatment, 23% of cost of treatment saved versus no stopping Genotype 1: 24-28% savings Genotype 2 or 3: 0-5% savings Savings similar to week 24 qualitative PCR
47 Genotype 2 or 3 Genotype 1 (and 4, 5 or 6) Peginterferon + ribavirin 800 mg 24 weeks HCV RNA detection at the end of treatment and 24 weeks later (lower limit of detection of the assay < 50 IU/mL ml) End-of of-treatment virological response Sustained virological response CHRONIC HEPATITIS C HCV genotype determination > 2 log HCV RNA decrease or HCV RNA (-)( at week 12 Continue until week 48 HCV RNA detection at the end of treatment and 24 weeks later (lower limit of detection of the assay < 50 IU/mL ml) End-of of-treatment virological response Sustained virological response Liver biopsy >A2F2 Peginterferon + ribavirin mg 48 weeks HCV RNA quantification at baseline and at week 12 (genotype 1) < A1F1 Follow-up without treatment < 2 log HCV RNA decrease at week 12 Stop treatment Enroll in trials of other therapies
48 Impact of IFN on Cirrhosis Cumulative Probability At 4 Years (%) IFN No IFN P-Value HCC <0.001 Decompensation <0.001 Survival <0.001 Predictors of survival: IFN therapy, albumin >3.4 g/dl Serfaty L. et al. Hepatology, 1998;27:1435
49 Regression of Cirrhosis Following Treatment of Hepatitis C Fibrosis stage Before and After Treatment With PEG-IFN α2b + RBV No of patients Reversion of cirrhosis 49% stage 4 stage 3 stage 2 stage 1 normal Before treatment After treatment Poynard T et al. Gastroenterology, 2002;122:1303
50 Impaired Virological Response in CH-C Patients with Advanced Liver Disease SVR pts treated with IFN +/- Ribavirin % P < % 10 0 Non-cirrhotic Cirrhotic Gastroenteral. 2004;126:1015
51 Peg-IFN-α-2b plus Ribavirin Therapy in CH-C with Cirrhosis or Pre-Cirrhosis SVR (%) % Genotype 1 (n=13) Naive 57% Genotype 2, 3 (n=15) 43% Genotype 1 (n=14) 57% Genotype 2, 3 (n=7) Previously IFN treated Peg-IFN-α-2b: 1.5 or/µg/kg weekly Ribavirin: mg daily 33% Relapses (n=6) 0% Previously I/R treated Non-responder (n=19) Marrache F. et al. AASLD 2003
52 Histologic Benefit of PEG-IFN α monotherapy In CH-C Patients with Advanced Fibrosis. N = 184 patients Liver biopsy: a median of 593 days apart Cirrhosis 76% Extensive bridging fibrosis 24% Table 1. Change from Baseline (post-base) for Fibrosis and Activity By subgroup Subgroup Stage/Grade N Mean P-value All Patients Fibrosis stage P<.0001 Activity grage P=.0039 SVR Fibrosis stage P<.0001 Activity grage P<.0001 Non-SVR Fibrosis stage P<.0001 Activity grage P=.7562 Everson G. et al. AASLD 2004
53 Peg-IFN / Ribavirin should always be considered in patients with child A cirrhosis Contraindication : severe PHT with endoscopic signs of high risk for bleeding : large splenomegaly with severe neutropenia and / or thrombocytopenia Alberti A. Barcelona
54
55
Prise 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 informationةي : لآا ةرقبلا ةروس
سورة البقرة: اآلية HCV RELAPSERS AND NONRESPONDERS: How to deal with them? BY Prof. Mohamed Sharaf-Eldin Prof. of Hepatology and Gastroenterology Tanta University Achieving SVR The ability to achieve a
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 informationManagement of CHC G1 patients who are relapsers or non-responders to Peg IFN and RBV therapy: Wait or Triple Therapy?
Management of CHC G1 patients who are relapsers or non-responders to Peg IFN and RBV therapy: Wait or Triple Therapy? Prof. Teerha Piratvisuth NKC Institute of Gastroenterology and Hepatology Prince of
More informationPegylated Interferon Alfa-2b (Peg-Intron) Plus Ribavirin (Rebetol)in the Treatment of Chronic Hepatitis C: A Local Experience
Pegylated Interferon Alfa-2b (Peg-Intron) Plus Ribavirin (Rebetol)in the Treatment of Chronic Hepatitis C: A Local Experience E L Seow, PH Robert Ding Island Hospital, Penang, Malaysia. Introduction Hepatitis
More informationHepatitis C: Management of Previous Non-responders with First Line Protease Inhibitors
Hepatitis C: Management of Previous Non-responders with First Line Protease Inhibitors Fred Poordad, MD The Texas Liver Institute Clinical Professor of Medicine University of Texas Health Science Center
More informationHepatitis C Treatment
Hepatitis C Treatment Standard of care & Managing advrse events Mohssen Nassiri Toosi, MD A s s o c i a t e P ro f e s s o r Of Internal M e d i c i n e Te h r a n U n i v e r s i t y O f M e d i c a l
More informationCurrent therapy for hepatitis C: pegylated interferon and ribavirin
Clin Liver Dis 7 (2003) 149 161 Current therapy for hepatitis C: pegylated interferon and ribavirin John G. McHutchison, MD a, Michael W. Fried, MD b, * a Duke Clinical Research Institute, Duke University
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 information5/12/2016. Learning Objectives. Management of Hepatitis C Virus Genotype 2 or 3 Infected Treatment-Naive or Experienced Patients
5/12/216 Management of Hepatitis C Virus Genotype 2 or 3 Infected Treatment-Naive or Experienced Patients Alexander Monto, MD Professor of Clinical Medicine University of California San Francisco San Francisco,
More informationViral hepatitis in reproductive health. Pierre Jean Malè. Training in Reproductive Health Research - Geneva 2006
Viral hepatitis in reproductive health Pierre Jean Malè Training in Reproductive Health Research - Geneva 2006 15.03.2006 HBV and HCV treatment Pierre-Jean Malè MD 15.03.2006 Global Impact of Hepatitis
More informationOptimal ltherapy in non 1 genotypes:
Optimal ltherapy in non 1 genotypes: genotype 2 and 3 patients Antonio Craxì GI & Liver Unit, Di.Bi.M.I.S. University of Palermo, Italy craxanto@unipa.it Peg IFN alpha plus ribavirin : SVR rate of >80%
More informationReviews/Evaluations. Chronic Hepatitis C. Introduction and Epidemiology. Natural Course of HCV. Recommendations for Treatment
Reviews/Evaluations Chronic Hepatitis C Introduction and Epidemiology Hepatitis C virus (HCV) is one of the most common blood-borne infections and cause of chronic liver disease in the United States (1).
More informationPrior Authorization Guideline
Prior Authorization Guideline Guideline Name Sovaldi (sofosbuvir) Formulary UnitedHealthcare Community & State Formulary Note Approval Date 2/19/2014 Revision Date 7/8/2014 1. Indications Drug Name: Sovaldi
More informationCASE STUDY. Adverse Events in treatment chronic hepatitis C patients with PegInterferon and Ribavirin What would your management decision be?
Adverse Events in treatment chronic hepatitis C patients with PegInterferon and Ribavirin What would your management decision be? CASE STUDY Pham Thi Thu Thuy MD, PhD Ho Chi Minh City Vietnam Serious Adverse
More informationTreatment Options in HCV Relapsers and Nonresponders. Raymond T. Chung, M.D.
Session IV Treatment Options in HCV Relapsers and Nonresponders Raymond T. Chung, M.D. Director of Hepatology, Massachusetts General Hospital, Associate Professor of Medicine, Harvard Medical School, Boston,
More informationLaboratory and Clinical Diagnosis of HCV Infection
Laboratory and Clinical Diagnosis of HCV Infection Jean-Michel Pawlotsky,, MD, PhD Department of Virology (EA 3489) Henri Mondor Hospital University of Paris XII Créteil,, France I Nonspecific Liver Tests
More informationPRACTICE GUIDELINES INTRODUCTION
American Journal of Gastroenterology ISSN 0002-9270 C 2006 by Am. Coll. of Gastroenterology doi: 10.1111/j.1572-0241.2006.00754.x Published by Blackwell Publishing PRACTICE GUIDELINES Management and Treatment
More informationClinical cases: HIV/HCV coinfection
Clinical cases: HIV/HCV coinfection José Vicente Fernández-Montero Hospital Carlos III, Madrid Case #1 General considerations about antiviral therapy CASE # 1 43 year-old, male patient Former IDU No prior
More information29th Viral Hepatitis Prevention Board Meeting
29th Viral Hepatitis Prevention Board Meeting Madrid, November 2006 Treatment of chronic hepatitis C José M. Sánchez-Tapias Liver Unit Hospital Clínic University of Barcelona Spain CHRONIC HEPATITIS C
More informationClinical Cases Hepatitis C Naïve Patients. Rafael Esteban Liver Unit. Hospital General Universitari Vall Hebron. Barcelona.
Clinical Cases Hepatitis C Naïve Patients Rafael Esteban Liver Unit. Hospital General Universitari Vall Hebron. Barcelona. Case study 1 27 year old woman, Diagnosed with Chronic Hepatitis C 3 years ago
More informationPrior Authorization Guideline
Prior Authorization Guideline Guideline Name Olysio (simeprevir) Formulary UnitedHealthcare Community & State Formulary Note Approval Date 2/19/2014 Revision Date 7/9/2014 1. Indications Drug Name: Olysio
More informationCHRONIC HCV TREATMENT: In Special Populations.
CHRONIC HCV TREATMENT: In Special Populations. By Taher EL-ZANATY Prof. of Internal Medicine CAIRO UNIVERSITY Introduction: HCV is the major cause of chronic hepatitis in Egypt. Its end stage is liver
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 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 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 informationMEDIC CENTER. Case 2
Case 2 Case history 57 year old Vietnamese man He lives in HCM city and works as a engineer The patient presented in July 2012 with fatigue Diagnosed with HCV in 2004 Negative for both HBV and HIV antibodies
More informationTopic: Sovaldi, sofosbuvir Date of Origin: March 14, Committee Approval Date: August 15, 2014 Next Review Date: March 2015
Medication Policy Manual Policy No: dru332 Topic: Sovaldi, sofosbuvir Date of Origin: March 14, 2014 Committee Approval Date: August 15, 2014 Next Review Date: March 2015 Effective Date: October 1, 2014
More informationHEPATITIS C UPDATES. Sanaa S. Said 10 th April, 2014
HEPATITIS C UPDATES Sanaa S. Said 10 th April, 2014 CONTENTS Introduction Epidemiology Transmission and Natural history Kenyan guidelines What is new? References INTRODUCTION Hepacivirus genus, Flaviviridae
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 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 informationWeight-Based Combination Therapy with Peginterferon α-2b and Ribavirin for Naïve, Relapser and Non-Responder Patients with Chronic Hepatitis C
BJID 2006; 10 (October) 311 Weight-Based Combination Therapy with Peginterferon α-2b and Ribavirin for Naïve, Relapser and Non-Responder Patients with Chronic Hepatitis C Fernando Lopes Gonçales Jr. 1,
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 informationPersonalizzazione della Cura in Epatologia. Epatite Cronica C: Pazienti con Genotipo 2
Monotematica AISF 213 Personalizzazione della Cura in Epatologia Pisa, 17-19 Ottobre 213 Epatite Cronica C: Pazienti con Genotipo 2 Maria Grazia Rumi U.O. Epatologia, Ospedale San Giuseppe Università degli
More informationPegylated Interferons and Ribavirins
Pegylated Interferons and Ribavirins Goal(s): Cover drugs only for those clients where there is evidence of effectiveness and safety Length of Authorization: 16 weeks plus 12-36 additional weeks or 12
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 informationTRANSPARENCY COMMITTEE
The legally binding text is the original French version TRANSPARENCY COMMITTEE OPINION 10 December 2008 REBETOL 200 mg capsules Pack of 84 (CIP code: 351 971.9) Pack of 112 (CIP code: 373 277.8) Pack of
More informationClinical Сase A previously relapse to PEG IFN + RBV in HCV G3a patient. Konstantin Zhdanov
Clinical Сase A previously relapse to PEG IFN + RBV in HCV G3a patient Konstantin Zhdanov Genotype 3 in Europe Canada Norway Germany Sweden Czech Republic Poland Approximately 1/3 of HCV-infected patients
More informationNew HCV reimbursement criteria Chronic hepatitis C regardless of fibrosis stage if:
New HCV reimbursement criteria 01-2018 Chronic hepatitis C with F2 fibrosis stage Chronic hepatitis C regardless of fibrosis stage if: HIV-HCV coinfection HBV-HCV coinfection Listed for or post-solid organ
More informationPatients with compensated cirrhosis: how to treat and follow-up
Patients with compensated cirrhosis: how to treat and follow-up Thomas Berg Sektion Hepatologie Klinik und Poliklinik für Gastroenterologie und Rheumatologie Universitätsklinikum Leipzig Leber- und Studienzentrum
More informationCase 4: A 61-year-old man with HCV genotype 3 with cirrhosis. Ira M. Jacobson, M.D. Weill Cornell Medical College New York, New York USA
Case 4: A 61-year-old man with HCV genotype 3 with cirrhosis Ira M. Jacobson, M.D. Weill Cornell Medical College New York, New York USA 1 Genotype 3 case 61-year-old man with HCV genotype 3 Cirrhosis on
More informationLiver 102: Injury and Healing
Liver 102: Injury and Healing Dawn Pease, MSN, RN, ANP-BC Brackenridge Specialty Clinics University Medical Center Brackenridge Austin, TX Seton Healthcare Family Liver 102 Outline Biochemical patterns
More informationASSAYS UTILZIED TO MONITOR HCV AND ITS TREATMENT
ASSAYS UTILZIED TO MONITOR HCV AND ITS TREATMENT Mitchell L Shiffman, MD Liver Institute of Virginia Bon Secours Health System Richmond and Newport News, VA Liver Institute of Virginia Education, Research
More informationApproved regimens for cirrhotic patients
5th Workshop on HCV THERAPY ADVANCES New antivirals in clinical practice Approved regimens for cirrhotic patients Amsterdam, 4-5 december 2015 Disease burden in Spain 400000 350000 300000 F0 Peak cirrhosis
More informationDr. Siddharth Srivastava
Dr. Siddharth Srivastava MD, DM (Gastroenterology) Associate Professor GIPMER, New Delhi Rashtriya Gaurav Award 2013 for work on hepatitis B and C Set up Liver clinic at GIPMER and in charge EUS laboratory.
More informationAbstract and Introduction. Patients and Methods. M. Hedenstierna; A. Nangarhari; A. El-Sabini; O. Weiland; S.
www.medscape.com Cirrhosis, High Age and High Body Mass Index Are Risk Factors for Persisting Advanced Fibrosis After Sustained Virological Response in Chronic Hepatitis C M. Hedenstierna; A. Nangarhari;
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 informationTransmission of HCV in the United States (CDC estimate)
Transmission of HCV in the United States (CDC estimate) Past and Future US Incidence and Prevalence of HCV Infection Decline among IDUs Overall incidence Overall prevalence Infected 20+ years Armstrong
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 informationAntiviral treatment in HCV cirrhotic patients on waiting list
Antiviral treatment in HCV cirrhotic patients on waiting list Krzysztof Tomasiewicz Department of Hepatology and Infectious Diseases Medical University of Lublin, Poland Disclosures Consultancy/Advisory
More informationSimeprevir + PEG + RBV in Treatment-Naïve Genotype 1 QUEST-1 Trial
Phase 3 Treatment Naïve Simeprevir + in Treatment-Naïve Genotype 1 QUEST-1 Trial Jacobson IM, et al. Lancet. 2014;384:403-13. Simeprevir + PEG + Ribavirin for Treatment-Naïve HCV GT1 QUEST-1 Trial QUEST-1
More informationHepatits C Criteria Direct Acting Antiviral Medications
Hepatits C Criteria Direct Acting Antiviral Medications Harvoni-Formulary PA required 1. Is the patient being treated for a funded condition by the Oregon Health Plan? 2. Does the member have a diagnosis
More informationNew York State HCV Provider Webinar Series. Overview of Fibrosis Staging, Child s Pugh, MELD Scores
New York State HCV Provider Webinar Series Overview of Fibrosis Staging, Child s Pugh, MELD Scores Objectives Discuss the rationale to assess fibrosis in HCV infected patients Review prevalence of advanced
More informationLength of Authorization: 8-16 weeks. Requires PA: All direct-acting antivirals for treatment of Hepatitis C. Approval Criteria
Hepatitis C Direct-Acting Antivirals Goals: Approve use of cost-effective treatments supported by the medical evidence. Provide consistent patient evaluations across all hepatitis C treatments. Ensure
More informationSAVINO BRUNO, MD Director Internal Medicine and Hepatology Unit AO Fatebenefratelli e Oftalmico, Milano
SAVINO BRUNO, MD Director Internal Medicine and Hepatology Unit AO Fatebenefratelli e Oftalmico, Milano Market wheretelaprevir has not yet launched Victrelis is still launching January 29 th 214 Developed
More informationLength of Authorization: 8-12 weeks. Requires PA: All direct-acting antivirals for treatment of Hepatitis C. Approval Criteria
Hepatitis C Direct-Acting Antivirals Goals: Approve use of cost-effective treatments supported by the medical evidence. Provide consistent patient evaluations across all hepatitis C treatments. Ensure
More informationLength of Authorization: 8-16 weeks. Requires PA: All direct-acting antivirals for treatment of Hepatitis C. Approval Criteria
Hepatitis C Direct-Acting Antivirals Goals: Approve use of cost-effective treatments supported by the evidence. Provide consistent patient evaluations across all hepatitis C treatments. Ensure appropriate
More informationNew HCV reimbursement criteria Chronic hepatitis C regardless of fibrosis stage if:
New HCV reimbursement criteria 01-2018 Chronic hepatitis C with F2 fibrosis stage Chronic hepatitis C regardless of fibrosis stage if: HIV-HCV coinfection HBV-HCV coinfection Listed for or post-solid organ
More informationSASKATCHEWAN FORMULARY BULLETIN Update to the 62nd Edition of the Saskatchewan Formulary
April 1, 2017 Bulletin #165 ISSN 1923-0761 SASKATCHEWAN FORMULARY BULLETIN Update to the 62nd Edition of the Saskatchewan Formulary Related Information for Prescribers: Only prescribers who have completed
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 informationIntron A Hepatitis C. Intron A (interferon alfa-2b) Description
Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 5.01.05 Subject: Intron A Hepatitis C Page: 1 of 5 Last Review Date: November 30, 2018 Intron A Hepatitis
More informationASSESSMENT PRIOR TO TREATMENT DO WE NEED IL28B TESTING?
ASSESSMENT PRIOR TO TREATMENT DO WE NEED IL28B TESTING? DO WE NEED LIVER BIOPSY? Mitchell L Shiffman, MD Director Liver Institute of Virginia Bon Secours Health System Richmond and Newport News, VA POTENTIAL
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 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 informationReview Optimizing outcomes in patients with hepatitis C virus genotype 2 or 3
Review Optimizing outcomes in patients with hepatitis C virus genotype 2 or 3 Thomas Berg 1 * and Giampiero Carosi 2 Antiviral Therapy 13 Suppl 1:17 22 1 Charite Universitatsmedizin Berlin, Berlin, Germany
More informationThe New World of HCV Therapy
HCV: Assessing the Patient Prior to Treatment: Diagnostic Testing and Strategy JORGE L. HERRERA, MD, MACG UNIVERSITY OF SOUTH ALABAMA COLLEGE OF MEDICINE, MOBILE, AL The New World of HCV Therapy Interferon-free
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 informationOptimal Dosing Frequency of Pegylated Interferon Alfa-2b Monotherapy for Chronic Hepatitis C Virus Infection
CLINICAL GASTROENTEROLOGY AND HEPATOLOGY 2005;3:610 615 Optimal Dosing Frequency of Pegylated Interferon Alfa-2b Monotherapy for Chronic Hepatitis C Virus Infection YOAV LURIE,* REGINE ROUZIER PANIS, GEORGE
More informationNew HCV reimbursement criteria Chronic hepatitis C regardless of fibrosis stage if:
New HCV reimbursement criteria 01-2017 Chronic hepatitis C with F2 fibrosis stage Chronic hepatitis C regardless of fibrosis stage if: HIV-HCV coinfection HBV-HCV coinfection Listed for or post-solid organ
More informationTreatment of Chronic Hepatitis C in HIV infection
Treatment of Chronic Hepatitis C in HIV infection June 25, 211 Andrew Talal, MD, MPH Associate Professor of Medicine Associate Medical Director Center for the Study of Hepatitis C Weill Cornell Medical
More informationTreating HCV Genotype 2 & 3
Treating HCV Genotype 2 & 3 3rd Workshop on HCV Therapy Advances, Rome 14.12.2013 Christoph Sarrazin Klinikum der J. W. Goethe-Universität Frankfurt am Main, Germany HCV Genotypes 2 & 3 Laurel and Hardy
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 informationHarvoni. Harvoni (ledipasvir & sofosbuvir) Description
Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 Subject: Harvoni Page: 1 of 7 Last Review Date: June 19, 2015 Harvoni Description Harvoni (ledipasvir &
More informationCurrent Standard of Care for Naïve HCV Patients (SVR)
Hepatitis C: Non-responders Nikunj Shah, MD Associate Professor of medicine University of Illinois Medical center 1 Current Standard of Care for Naïve HCV Patients (SVR) 1 8 8 6 53 45 4 6 52 46 4 2 2 Peg
More informationC-CREST study, Part A: GZR + EBR or MK MK-3682 for genotypes 1, 2 and 3 - Phase II
Design 18 years Chronic HCV infection Genotype 1, 2 or 3 Treatment-naïve HCV RNA 1 IU/ml No cirrhosis * No HBV or HIV co-infection Randomisation Open-label * Liver biopsy or Fibroscan 12.5 kpa or Fibrotest
More informationAin Shams University. The Egyptian Journal of Medical Human Genetics.
The Egyptian Journal of Medical Human Genetics (2012) 13, 331 335 Ain Shams University The Egyptian Journal of Medical Human Genetics www.ejmhg.eg.net www.sciencedirect.com ORIGINAL ARTICLE Virologic response
More informationLength of Authorization: 8-16 weeks. Requires PA: All direct-acting antivirals for treatment of Hepatitis C. Approval Criteria
Hepatitis C Direct-Acting Antivirals Goals: Approve use of cost-effective treatments supported by the evidence. Provide consistent patient evaluations across all hepatitis C treatments. Ensure appropriate
More informationManagement of Incidental Hepatitis C Virus Infection
The new england journal of medicine Clinical Decisions Interactive at nejm.org Management of Incidental Hepatitis C Virus Infection This interactive feature addresses the diagnosis or management of a clinical
More informationPierluigi Toniutto Clinica di Medicina Interna Azienda Ospedaliero Universitaria Udine
Pierluigi Toniutto Clinica di Medicina Interna Azienda Ospedaliero Universitaria Udine Il sottoscritto dichiara di non aver avuto negli ultimi 12 mesi conflitto d interesse in relazione a questa presentazione
More informationProtease inhibitor based triple therapy in treatment experienced patients
Protease inhibitor based triple therapy in treatment experienced patients Universitätsklinikum Leipzig Thomas Berg Sektion Hepatologie Klinik und Poliklinik für Gastroenterologie und Rheumatologie Leber
More informationHepatitis B and Interferon Philippe Sogni Paris-Descartes University, INSERM U-1016 and Hepatology unit, Cochin hospital, Paris; France PHC 2015
Hepatitis B and Interferon Philippe Sogni Paris-Descartes University, INSERM U-1016 and Hepatology unit, Cochin hospital, Paris; France PHC 2015 1 Prof. Philippe SOGNI, M.D., Ph.D. Affiliations Institut
More informationPatients must have met all of the following inclusion criteria to be eligible for participation in this study.
Supplementary Appendix S1: Detailed inclusion/exclusion criteria Patients must have met all of the following inclusion criteria to be eligible for participation in this study. Inclusion Criteria 1) Willing
More informationV.G. Bain, P. Marotta, K. Kaita, E. Yoshida, M. Swain, R. Bailey, A. Neumann, P. Cronin, J. McHutchison, E. Pulkstenis, M.
COMPARABLE ANTIVIRAL RESPONSE RATES WITH ALBINTERFERON ALFA-2B DOSED AT Q2W OR Q4W INTERVALS IN NAIVE SUBJECTS WITH GENOTYPE 2 OR 3 CHRONIC HEPATITIS C V.G. Bain, P. Marotta, K. Kaita, E. Yoshida, M. Swain,
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 informationThe New World of HCV Therapy
HCV: Assessing the Patient Prior to Treatment: Diagnostic Testing and Strategy JORGE L. HERRERA M.D., MACG UNIVERSITY OF SOUTH ALABAMA COLLEGE OF MEDICINE, MOBILE, AL The New World of HCV Therapy Interferon-free
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 informationHarvoni. Harvoni (ledipasvir & sofosbuvir) Description
Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 5.01.32 Subject: Harvoni Page: 1 of 9 Last Review Date: December 2, 2016 Harvoni Description Harvoni (ledipasvir
More informationThe Future is Here Now!
HCV Treatment: Assessing the Patient Prior to Treatment. How Will This Change in the Future? JORGE L. HERRERA M.D., FACG UNIVERSITY OF SOUTH ALABAMA COLLEGE OF MEDICINE, MOBILE, AL The Future is Here Now!
More informationAnemia in the Treatment of Hepatitis C Virus Infection
SUPPLEMENT ARTICLE Anemia in the Treatment of Hepatitis C Virus Infection Mark S. Sulkowski Center for Viral Hepatitis, Johns Hopkins University, Baltimore, Maryland Hepatitis C virus (HCV) infection is
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 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 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 informationHarvoni. Harvoni (ledipasvir & sofosbuvir) Description
Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 5.03.32 Subject: Harvoni Page: 1 of 7 Last Review Date: December 3, 2015 Harvoni Description Harvoni (ledipasvir
More informationPegasys Pegintron Ribavirin
Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 5.01.47 Subsection: Anti-infective nts Original Policy Date: January 1, 2019 Subject: Pegasys Pegintron
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 informationHow do you optimize HCV Treatment for Cirrhotic Patients APASL STC Cebu
How do you optimize HCV Treatment for Cirrhotic Patients APASL STC Cebu Seng Gee Lim Chairman, APASL Liver Week 2013 Professor of Medicine Dept of Gastroenterology and Hepatology NUHS, Singapore Disclosures
More informationInvasive. Sampling error. Interobserver variability. Nondynamic evaluation of
How to assess liver fibrosis Serum markers or FibroScan vs. liver biopsy? Laurent CASTERA & Pierre BEDOSSA Hôpital Beaujon, AP-HP, Clichy Université Paris-VII France 4 th Paris Hepatitis Conference, Paris,
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 informationHepatitis C Update. Geri Brown, M.D. Associate Professor Department of Internal Medicine March 24, 2011
Hepatitis C Update Geri Brown, M.D. Associate Professor Department of Internal Medicine March 24, 2011 Outline n Educational Objectives Epidemiology and Natural History of Hepatitis C Current Treatment
More informationInterferon free therapy Are we getting there? Graham R Foster Queen Marys University of London
Interferon free therapy Are we getting there? Graham R Foster Queen Marys University of London IFN free therapy Disclosures I have received personal and institutional funding from companies that sell drug
More information