HBV screening and management in HIV-infected children and adolescents
|
|
- Beverly Francis
- 8 years ago
- Views:
Transcription
1 HBV screening and management in HIV-infected children and adolescents Linda Aurpibul M.D. Research Institute for Health Sciences, Chiang Mai University
2 8% HIV and Hepatitis B Co-infection Among Perinatally HIV-infected Thai Adolescents 521 perinatally HIV-infected children and adolescents were screened Their mean current age was 14.8 years (SD 2.1) Hepatitis B serostatus Total Prevalence (95% CI) -Chronic Hepatitis B ( ) -Isolated core antibody ( ) -Resolved natural HBV infection ( ) -Having seroprotection from previous immunization ( )
3 Concern in HIV-infected adolescents with HBV co-infection Risk of transmission via sexual activity, IDU Risk of liver disease progression Long duration on ART It s time for transition to adult care sooner or later we need to let them go!
4 Case One HBs Ag positive in perinatally HIV-infected child on ART
5 History A 14.7 years old adolescent boy has been initiated on antiretroviral therapy (nevirapine-based regimen) since the year Date Wk Age (yr) Wt (kg) Ht (cm) CD4(%) VL (cp/ml) ART regimen 6 Aug (1) 167,605 GPO vir 20 Jan (6) < 50 (3TC+d4T+NVP) 25 Sep (25) < 50 GPO vir Z 15 Nov (20) <40 (3TC+ZDV+NVP)
6 History (cont ) On 15 Nov 2010 he participated in hepatitis B screening program. The following hepatitis B profile was obtained; HBs Ag positive Anti-HBs negative Anti-HBc positive
7 Q1: What is your advice for this boy? A. He has no immune against hepatitis B; hepatitis B vaccination is needed. B. He has to see hepatologist for further management C. Another blood draw to confirm HBsAg status is needed
8 Discussion Answer A is not appropriate as the boy might have chronic hepatitis B infection. Thus, he would not get any benefit from re-immunization. Answer B is not the good option, we might be able to do some more thing for him before making a consultation with other subspecialty Answer C is the best choice, he should be re-tested in order to determine hepatitis B serostatus (Chronic hepatitis B is defined as having HBs Ag positive for > 6 Mo)
9 Why mention HBV-HIV co-infection? In HIV-infected patients, HBV symptoms usually mild or asymptomatic. Rate of hepatitis B clearance is lower 20-40% of patients progress to chronic hepatitis B infection (HBs Ag positive for > 6 Mo) Could progress to liver cancer more rapidly than general population
10 Four phase of chronic hepatitis B (as described in HIV negative patients) HBeAg positive negative Liver inflammation determined by: -ALT level, -liver fibroscan, -liver biposy yes no Immune active Immune tolerant Chronic active Inactive carrier In HIV-positive patients, utility of this classification and frequency of each type are not yet known. British HIV Association guidelines for the management of co-infection with HIV-1 and hepatitis B or C virus HIV Med 2010;11:1-30
11 Immune tolerant phase is general seen in people infected in childhood
12 History (cont ) He was appointed to come to clinic on 7 Feb2011, but he did not appear due to his school activities. His uncle came to pick up ARV drugs for him and promised to bring him in for subsequent visit on 2 May May2011 HBs Ag positive Anti-HBe negative HBe Ag positive 2 May2011 AST 15 ALT 32 Note: Specimen left over was sent for HBeAg, anti Hbe, and liver transaminase
13 Q2: Will you modify ARV regimen for this boy? A No, there is no need as lamivudine is a potent anti-hbv agent, and he is currently HIV viral suppressed B Yes, his ARV regimen should compose of 2 drugs active against both HIV and HBV. C I am not sure what to do.
14 Discussion Answer A is not the best option according to the current knowledge. Answer B is the right answer If your answer is C.WAKE UP please! 3TC resistant HBV is observed in approximately 40% of patients after 2 years on 3TC and in 90% of patients after 4 years when it is used as the only active drug for HBV in coinfected patients. M204V develops at a rate of 25% per year (Benhamou, 1999)
15 Discussion What drug should be added? Drugs with anti-hbv and HIV activity Lamivudine Emtricitabine Tenofovir Entecavir (weak against HIV) Drugs with anti- HBV activity only Interferon Adefovir Telbivudine Tenofovir is effective at suppressing HBV DNA and may induced HBeAg seroconversion.
16 Q3: Any more test(s) to be performed at the time of treatment modification? A. yes, HBV DNA PCR ± HBV resistance testing B. yes, liver ultrasonography and/or fibroscan C. yes, anti-hav, anti-hcv, and delta virus D. no, none is necessary
17 Discussion HBV DNA measurement Arbitrary cut-off value 20,000 IU/mL (10 5 copies/ml) is associated with risk of progressive liver disease, and accepted threshold for treatment consideration is > 2,000 IU/mL Help in distinguish replicative from non-replicative chronic hepatitis B Essential in subsequent disease monitoring Liver fibrosis assessment (not recommended by gastroenterologist at our site) Could be done sometime later during follow-up period HBV resistance testing May be considered (if feasible) as a baseline evaluation for those previously exposed to anti-hbv drugs
18 Q4: How to determine efficacy of HBV treatment? A. Measure HBV DNA PCR level B. Look for HBe Ag seroconversion C. Follow ALT level D. Perform HBV resistant testing to see if there is a resistance mutation or not
19 Discussion Goal of treatment in HBV monotherapy: HBeAg seroconversion (from positive to negative, could be expected wk after HBV DNA become undetectable) Normalization of ALT Realistic goal in those with coinfection: To stop or delay progression of hepatic fibrosis by suppression of HBV replication to undetectable levels. HIV DNA testing is essential for monitoring of disease Response = undetectable HBV DNA within 48 weeks of treatment Primary nonresponse = having a < 1 log 10 IU/mL drop in HBV DNA level from baseline at 3 months on treatment ALT elevation is a less sensitive indicator of disease severity in patients with co-infection
20 Case Two All negative
21 History A 18.7 years old adolescent boy Perinatally HIV-infected, initiated on ART since 2002 Date Age (yr) Wt (kg) Ht (cm) CD4(%) VL (cp/ml) ART regimen 5 Nov (3) 516,619 GPO vir (3TC+d4T+NVP) 26 Apr Virologic failure 279(13) 9,905 IDV+LPV/r 4 Feb Simplify regimen 625(26) <50 Zilavir(3TC+ZDV) +LPV/r 11 Oct (24) <40
22 History (cont ) On 22 Nov 2010 he participated in hepatitis B screening program. He has a document of completed childhood vaccination including hepatitis B. 22 Nov 2010 HBs Ag negative Anti-HBs negative Anti-HBc negative
23 Q1: What is the most important message for this boy? A. Good news! He has no hepatitis B infection; there is nothing to be done now, but re-testing every years is advised once he becomes sexually active. B. He is at risk for hepatitis B infection as he has no immune against hepatitis B. HBV revaccination is recommended as his current CD4 is > 350 cells/ul C. He is considered as a HBV vaccine non responder, additional boosting would not be beneficial in this case. He should be counseled regarding the risk of HBV infection
24 Discussion Optimizing protection against hepatitis B is important in HIV-positive individual. Antibody responses to HBV vaccine are inferior and less likely to persist with time when compared to non-hiv population. Revaccination is recommended after being on ART and once the CD4 cell count is above 350 cells/ul
25 Q2: What is the HBV vaccine schedule will you advise for him? A. A single booster dose is sufficient B. 3 standard dose at 0, 2, 6 months, IM C. 3 standard dose at 0, 2, 6 months, ID D. 3 double doses at 0, 2, 6 months, IM
26 Discussion Additional HBV vaccine in HIV-infected adults with non-response to initial standard dose Study HBV vaccine Response rate Bloom 2009 C 1-3 standard dose, IM 29% Theodora 2008 D 3 double dose, IM 50.7% Cruciani 2009 E 1-2 double dose, IM 73% C JAIDS 2008;50: D JID2008;197: E Vaccine 2009;27:17-22.
27 Discussion HBV revaccination in HIV-infected children after immune recovery Study Age of participants HBV vaccine Response rate Lao-araya M 2007 A 10.1 ± 2.4 yrs 3 standard dose, IM 92.1% Bunupuradah T 2011 B 1-18 yrs 3 standard dose, ID 90.2% 3 standard dose, IM 92.3% Persistence of antibody was detected in approximately 70% of cases at 3 years after HBV re-vaccination. c Yearly anti-hbs level measurement and subsequent booster dose of HBV vaccine is advised if anti-hbv falls below 100 IU/L (BHIVA2010) A Vaccine 2007;25:5324-9, B Vaccine 2011; in press, c Vaccine 2011:29;
28 Case Three Antiretroviral naïve adolescent girl
29 History A 12 years old adolescent girl has just been diagnosed as HIV-positive after her presentation at a community hospital with severe pneumonia. She has a history of recurrent chronic otitis media since the age of 4. Failure to thrive (unexplained stunting) was documented. Her BW was 23.5 kg, Ht 131 cm, CD4 lymphocyte count 67 cells/mm 3 (2%), HIV RNA PCR 17,260 copies/ml She has been living with her aunt after her mother has passed away of unknown cause, her father had left for years without any contact.
30 Q1: Will you order hepatitis B profile for this case prior to ART initiation? A. no, it is not necessary at this moment B. yes, it will affect our decision on ARV regimen C. depends on her health care coverage
31 Discussion Rationale for HBV screening prior to ART initiation Uncertain history of hepatitis immunization Born to mother with hepatitis B carrier Older adolescents who might acquire both HIV and HBV via sexual transmission Population with high prevalence of hepatitis B infection
32 History (cont ) The following hepatitis B profile was obtained; 29 Nov2010 -HBs Ag positive Anti-HBs negative Anti-HBc positive
33 Q2: What should be the first line ARV regimen of choice for this girl? A. 3TC+d4T+NVP B. 3TC+TDF+EFV C. 3TC+TDF+LPV/r
34 Discussion A. nevirapine with potential hepatotoxicity could be used with caution! B two active drugs against both infection is advised C. PI-based regimen is not recommended to be used as a first regimen except for young children < 24 Mo who have been exposed to NNRTI (WHO2010)
35 Take home message Screen your new and old patients for Hepatitis B status For those with co-infection, provide 2 active agents against both infection to suppress both virus to undetectable levels, and reduce chance of developing viral resistance Follow those children for disease progression and liver outcome, AND don t forget to share with all of us whatever you learnt
36 Wat Chan,Chiang Mai, Thailand Thank you for your attention
HIV and Hepatitis Co-infection. Martin Fisher Brighton and Sussex University Hospitals, UK
HIV and Hepatitis Co-infection Martin Fisher Brighton and Sussex University Hospitals, UK Useful References British HIV Association 2010 http://www.bhiva.org/documents/guidelines/hepbc/2010/ hiv_781.pdf
More informationViral Hepatitis Case Report
Page 1 of 9 Viral Hepatitis Case Report Perinatal Hepatitis B Virus Infection Michigan Department of Community Health Communicable Disease Division Investigation Information Investigation ID Onset Date
More informationHepatitis B and C Co-infection. Mark Hull MHSc, FRCPC Clinical Assistant Professor Division of AIDS
Hepatitis B and C Co-infection Mark Hull MHSc, FRCPC Clinical Assistant Professor Division of AIDS Objectives Review natural history of hepatitis coinfection Brief overview of treatment indications for
More informationMolecular Diagnosis of Hepatitis B and Hepatitis D infections
Molecular Diagnosis of Hepatitis B and Hepatitis D infections Acute infection Detection of HBsAg in serum is a fundamental diagnostic marker of HBV infection HBsAg shows a strong correlation with HBV replication
More informationWhen an occupational exposure occurs, the source patient should be evaluated for both hepatitis B and hepatitis C. (AII)
XI. OCCUPATIONAL EXPOSURES TO HEPATITIS B AND C RECOMMENDATION: When an occupational exposure occurs, the source patient should be evaluated for both hepatitis B and hepatitis C. (AII) The risk of transmission
More information2015 Outpatient Chronic Hepatitis B Management
2015 Outpatient Chronic Hepatitis B Management Hepatitis B Hepatitis B Info 70% of acute infections are subclinical More severe symptoms when in addition to other liver disease Fulminant Hepatitis
More informationAntiretroviral therapy for HIV infection in infants and children: Towards universal access
Antiretroviral therapy for HIV infection in infants and children: Towards universal access Executive summary of recommendations Preliminary version for program planning 2010 Executive summary Tremendous
More informationHBV DNA < monitoring interferon Rx
Hepatitis B Virus Suspected acute hepatitis >>Order: Acute Unknown hepatitis screen Suspected chronic hepatitis >>Order: Chronic unknown hepatitis screen Acute HBV or Delayed Anti HBs response after acute
More informationManagement of Chronic Hepatitis B: 2012 Update
Management of Chronic Hepatitis B: 2012 Update Brian J McMahon MD, Liver Disease and Hepatitis Program Alaska Native Medical Center and Arctic Investigations Program, CDC Conflicts of Interest The Liver
More informationHIV and Hepatitis B CoInfection
HIV and Hepatitis B CoInfection Douglas G. Fish, MD June 3, 2014 44 yo male with AIDS who had fallen out of care and returned in October 2013 Last seen in November 2012 CD4 at that time 340 cells/cmm HIV
More informationHEPATITIS COINFECTIONS
HEPATITIS COINFECTIONS Kenneth E. Sherman, MD, PhD Gould Professor of Medicine Director, Division of Digestive Diseases University of Cincinnati College of Medicine Disclosures (Activity w/i 12 months)
More informationEASL INTERNATIONAL CONSENSUS CONFERENCE ON HEPATITIS B 13 14 September, 2002 Geneva, Switzerland Consensus statement (Short version)
Journal of Hepatology 38 (2003) 533 540 Special article EASL INTERNATIONAL CONSENSUS CONFERENCE ON HEPATITIS B 13 14 September, 2002 Geneva, Switzerland Consensus statement (Short version) The EASL Jury*
More informationLong-term Results of Pegylated Interferon alfa-2a and Tenofovir for Hepatitis B
Long-term Results of Pegylated Interferon alfa-2a and Tenofovir for Hepatitis B Patrick Marcellin Viral Hepatitis Research Center Hôpital Beaujon, University of Paris France OBJECTIVES OF THERAPY IN CHRONIC
More informationImpact of natural boostering on long-term protection against hepatitis B after newborn (HBsAg + mothers) vaccination.
Impact of natural boostering on long-term protection against hepatitis B after newborn (HBsAg + mothers) vaccination Roznovsky Ludek Department of Infectious Diseases University Hospital Ostrava, Czech
More informationWilliam Atkinson, MD, MPH Hepatitis B Vaccine Issues June 16, 2016
William Atkinson, MD, MPH Hepatitis B Vaccine Issues June 16, 2016 Advisory Committee on Immunization Practices (ACIP) The recommendations to be discussed are primarily those of the ACIP composed of 15
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 informationHEPATITIS B VIRUS II. HEPATITIS B VIRUS RECOMMENDATIONS:
HEPATITIS B VIRUS II. HEPATITIS B VIRUS Hepatitis B virus (HBV) is a major cause of acute and chronic hepatitis worldwide. In the United States, approximately 250,000 to 300,000 new HBV infections occur
More informationPURPOSE: To define the criteria to be used to determine the medical necessity of antiviral therapy in the treatment of Chronic Hepatitis B.
COVENTRY Health Care Guidelines for Hepatitis B Therapy SUBJECT: Chronic Hepatitis B Therapy: a. Interferons - Intron A (interferon alfa-2b) and Pegasys (peginterferon alfa-2a) b. Nucleoside analogues
More informationGuidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents
Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents Visit the AIDSinfo website to access the most up-to-date guideline. Register for e-mail notification of guideline
More informationChronic hepatitis B (CHB) remains an important public SPECIAL REPORT
CLINICAL GASTROENTEROLOGY AND HEPATOLOGY 2008;6:1315 1341 SPECIAL REPORT A Treatment Algorithm for the Management of Chronic Hepatitis B Virus Infection in the United States: 2008 Update EMMET B. KEEFFE,*
More informationHCV/HIVCo-infection A case study by. Dominic Côté, Nurse Clinician B.Sc Chronic Viral Illness Services McGill University Health Centre
HCV/HIVCo-infection A case study by Dominic Côté, Nurse Clinician B.Sc Chronic Viral Illness Services McGill University Health Centre Objectives By sharing a case study of a patient co-infected with HIV/HCV
More informationOptimising therapy in chronic hepatitis B: Switch or add treatment
Optimising therapy in chronic hepatitis B: Switch or add treatment Teerha Piratvisuth NKC Institute of Gastroenterology and Hepatology Prince of Songkla University,Thailand NA + NA Percent with resistance
More informationUpdate on Pharmacotherapy of Chronic Hepatitis B and C
Update on Pharmacotherapy of Chronic Hepatitis B and C Rebecca L. Corey, Pharm.D., BCPS Reviewed by Paulina Deming, B.S., Pharm.D., PhC; Lisa C. Hutchison, Pharm.D., MPH, FCCP, BCPS; and Hannah R. Howell,
More information12/2/2015 HEPATITIS B AND HEPATITIS C BLOOD EXPOSURE OBJECTIVES VIRAL HEPATITIS
HEPATITIS B AND HEPATITIS C BLOOD EXPOSURE DISEASE 101 ONLINE CONFERENCE SARAH WENINGER, MPH VIRAL HEPATITIS.STD.HIV PREVENTION COORDINATOR DECEMBER 3, 2015 OBJECTIVES Describe the populations that should
More informationTESTING AND MANAGEMENT. Dr Nicole Allard GP Cohealth, Joslin Clinic, West Footscray PhD student, Epidemiology Unit VIDRL
TESTING AND MANAGEMENT Dr Nicole Allard GP Cohealth, Joslin Clinic, West Footscray PhD student, Epidemiology Unit VIDRL Disclosure and acknowledgments No conflicts of interest Board Member of Hepatitis
More informationHBV Treatment Guidelines. By: Prof.Dr. Abdelfatah Hanno Professor of Tropical Medicine Alexandria Faculty of Medicine
HBV Treatment Guidelines By: Prof.Dr. Abdelfatah Hanno Professor of Tropical Medicine Alexandria Faculty of Medicine A 29 Y old lady diagnosed as chronic HBV 3 years ago during her pregnancy, no treatment
More informationEASL Clinical Practice Guidelines: Management of chronic hepatitis B
Journal of Hepatology 50 (2009) 227 242 www.elsevier.com/locate/jhep EASL Clinical Practice Guidelines: Management of chronic hepatitis B European Association for the Study of the Liver * Keywords: Hepatitis
More informationManagement of Chronic Hepatitis B: Consensus Guidelines
Management of Chronic Hepatitis B: Consensus Guidelines Morris Sherman MD PhD 1, Stephen Shafran MD 2, Kelly Burak MD 3, Karen Doucette MD 2, Winnie Wong MD 2, Nigel Girgrah MD 1, Eric Yoshida MD 4, Eberhard
More informationThe Basics of Drug Resistance:
CONTACT: Lisa Rossi +1-412-641-8940 +1-412- 916-3315 (mobile) rossil@upmc.edu The Basics of Drug Resistance: QUESTIONS AND ANSWERS HIV Drug Resistance and ARV-Based Prevention 1. What is drug resistance?
More informationLiver Disease and Therapy of Hepatitis B Virus Infections
Liver Disease and Therapy of Hepatitis B Virus Infections University of Adelaide Catherine Scougall Arend Grosse Huey-Chi Low Allison Jilbert Fox Chase Cancer Center Chunxiao Xu Carol Aldrich Sam Litwin
More informationStepwise Approach for Detecting, Evaluating, and Treating Chronic Hepatitis B Virus Infection
Stepwise Approach for Detecting, Evaluating, and Treating Chronic Hepatitis B Virus Infection Federal Bureau of Prisons Clinical Practice Guidelines January 20, 2011 Clinical guidelines are made available
More informationTheonest Ndyetabura KILIMANJARO CHRISTIAN MEDICAL CENTRE / KILIMANJARO CLINICAL RESERCH
TREATMENT FAILURE AND PATTERNS OF GENOTYPIC DRUG RESISTANCE MUTATIONS AMONG HAART EXPERIENCED HIV-1 PATIENTS AT KCMC Theonest Ndyetabura KILIMANJARO CHRISTIAN MEDICAL CENTRE / KILIMANJARO CLINICAL RESERCH
More informationCase Finding for Hepatitis B and Hepatitis C
Case Finding for Hepatitis B and Hepatitis C John W. Ward, M.D. Division of Viral Hepatitis Centers for Disease Control and Prevention Atlanta, Georgia, USA Division of Viral Hepatitis National Center
More informationBHIVA Guidelines for the Management of Hepatitis Virus Infection in Adults
DOI: 10.1111/hiv.12106 British HIV Association guidelines for the management of hepatitis viruses in adults infected with HIV 2013 NHS Evidence has accredited the process used by the British HIV Association
More informationTreatment Strategies of Hepatitis B in China
Treatment Strategies of Hepatitis B in China Guangbi Yao MD Shanghai Jing-An Qu Central Hospital 200040 Characteristic features of CHB in China Huge amount of patients Infection during early life Maternal
More information1.1.2 Amend the that the Special Authority relating to tenofovir for use in pregnancy for postpartum care;
Anti-Infective Subcommittee of PTAC Meeting held 1 March 2012 (minutes for web publishing) Anti-Infective Subcommittee minutes are published in accordance with the Terms of Reference for the Pharmacology
More informationThe availability of newer antiviral agents, as
TREATMENT OF HEPATITIS B VIRUS INFECTION * Norman L. Sussman, MD ABSTRACT In treating chronic hepatitis B virus (HBV) infection, the primary goal of therapy is to achieve sustained suppression of HBV replication,
More informationAASLD PRACTICE GUIDELINES Chronic Hepatitis B: Update 2009
AASLD PRACTICE GUIDELINES Chronic Hepatitis B: Update 2009 Anna S. F. Lok 1 and Brian J. McMahon 2 This guideline has been approved by the American Association for the Study of Liver Diseases and represents
More informationBody Fluid Exposure:
Focus on CME at the University of Manitoba Focus on CME at the University of Manitoba Body Fluid Exposure: What To Do? John Sokal, MD, CFPC Presented at Bug Day 2003, Health Sciences Centre, Winnipeg (October
More informationDr. Abonyi Margit PhD SE 1st Medical Clinic Associate Professor. Hepatology-2014
Dr. Abonyi Margit PhD SE 1st Medical Clinic Associate Professor Hepatology-2014 Other virus hepatitis Epstein-Barr vírus Cytomegalo vírus Herpes simplex vírus Coxsackie vírus Hepatitis B vírus Hepadnavírus,
More informationRoutine HIV Monitoring
Routine HIV Monitoring Guideline of the HIV/AIDS Division at San Francisco General Hospital Statement of Guideline: Patients will be routinely evaluated and monitored for HIV parameters, antiretroviral
More informationAASLD PRACTICE GUIDELINES Chronic Hepatitis B
AASLD PRACTICE GUIDELINES Chronic Hepatitis B Anna S. F. Lok 1 and Brian J. McMahon 2 This guideline has been approved by the American Association for the Study of Liver Diseases and represents the position
More informationGuidelines for the Management of Occupational Exposures to HBV, HCV, and HIV and Recommendations for Postexposure Prophylaxis
Guidelines for the Management of Occupational Exposures to HBV, HCV, and HIV and Recommendations for Postexposure Prophylaxis Hepatitis B Virus (HBV), Hepatitis C Virus (HCV), and Human Immunodeficiency
More informationProspects for Vaccines against Hepatitis C Viruses. T. Jake Liang. M.D. Liver Diseases Branch NIDDK, NIH, HHS
Prospects for Vaccines against Hepatitis C Viruses T. Jake Liang. M.D. Liver Diseases Branch NIDDK, NIH, HHS HCV Vaccine Prevention strategies Protective immunity Barriers and solutions Vaccine candidates
More informationCo-infected health-care workers
Co-infected health-care workers Y.Yazdanpanah Service Universitaire des Maladies Infectieuses et du Voyageur C.H. Tourcoing, Faculté de Médecine de Lille CNRS U362, Lille, France Co-infected health-care
More informationOffering Testing for Hepatitis B and C in Primary Care
Offering Testing for Hepatitis B and C in Primary Care Presentation 3 January 2014 Quality Education for a Healthier Scotland 1 Learning Outcomes Participants will be able to:- Undertake a pre-test discussion
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 informationHEPATITIS WEB STUDY Acute Hepatitis C Virus Infection: Epidemiology, Clinical Features, and Diagnosis
HEPATITIS WEB STUDY Acute C Virus Infection: Epidemiology, Clinical Features, and Diagnosis H. Nina Kim, MD Assistant Professor of Medicine Division of Infectious Diseases University of Washington School
More informationPreface. TTY: (888) 232-6348 or cdcinfo@cdc.gov. Hepatitis C Counseling and Testing, contact: 800-CDC-INFO (800-232-4636)
Preface The purpose of this CDC Hepatitis C Counseling and Testing manual is to provide guidance for hepatitis C counseling and testing of individuals born during 1945 1965. The guide was used in draft
More informationThe Natural History of Chronic Hepatitis B Virus Infection
The Natural History of Chronic Hepatitis B Virus Infection Brian J. McMahon, M.D. 1 ABSTRACT Three stages of chronic hepatitis B virus (HBV) infection are recognized: the immune tolerant phase, the chronic
More informationTreatment of Hepatitis B
Treatment of Hepatitis B Paul Y Kwo, MD Professor of Medicine Gastroenterology/Hepatology Division Medical Director, Liver Transplantation Indiana University Health Indiana University School of Medicine
More informationCombination Anti-Retroviral Therapy (CART) - Rationale and Recommendation. M Dinaker. Fig.1: Effect of CART on CD4 and viral load
Combination Anti-Retroviral Therapy (CART) - Rationale and Recommendation M Dinaker INTRODUCTION The wide availability of effective, safe and mostly well tolerated combined anti-retroviral therapy (CART)
More informationSafety of Nucleos(t)ide Analogues during Long-Term Treatment of Chronic Hepatitis B
Safety of Nucleos(t)ide Analogues during Long-Term Treatment of Chronic Hepatitis B Anna S. F. Lok, MD Alice Lohrman Andrews Research Professor in Hepatology Director of Clinical Hepatology University
More informationVirology. Behandlung der Hepatitis B. HBV Genome. HBV life cycle. HBV Genotypes. Natural History. 8 genotypes: A, B, C, D, E, F, G, H
Virology Behandlung der Hepatitis B Markus Heim Universitätsspital Basel 1 2 HBV Genome HBV life cycle 3 4 HBV Genotypes Natural History 8 genotypes: A, B, C, D, E, F, G, H genotypes A and D are prevalent
More informationBloodborne Pathogens (HIV, HBV, and HCV) Exposure Management
Bloodborne Pathogens Exposure Policy and Procedures Employees of the State of South Dakota Department of Health Bloodborne Pathogens (HIV, HBV, and HCV) Exposure Management PEP Hotline 1-888-448-4911 DOH
More informationAre Booster Doses of Hepatitis B Vaccine Necessary?
Are Booster Doses of Hepatitis B Vaccine Necessary? Current CDC Recommendations And Gaps in Knowledge Division of Viral Hepatitis Centers for Disease Control and Prevention, USA Current United States Recommendations
More informationPERINATAL AND CHILDHOOD HEPATITIS.. WHAT ABOUT THE CHILDREN?
PERINATAL AND CHILDHOOD HEPATITIS.. WHAT ABOUT THE CHILDREN? John T. Stutts, MD, MPH University of Louisville School of Medicine Department of Pediatrics Division of Pediatric Gastroenterology, Hepatology
More informationMedical publications on HBV and HCV Coinfection
Recent advances of HBV and HCV co-infection 台 中 榮 總 內 科 部 胃 腸 肝 膽 科 呂 宜 達 醫 師 2013.03.28 Outline Epidemiology of HBV and HCV coinfection Clinical significance of HBV and HCV coinfection Interplay between
More informationIn Tanzania, ARVs were introduced free-of-charge by the government in 2004 and, by July 2008, almost 170,000 people were receiving the drugs.
ANTIRETROVIRAL TREATMENT What is ART and ARV? ART is a short form for Antiretroviral Therapy (or Treatment). Antiretroviral therapy is a treatment consisting of a combination of drugs which work against
More informationEfficacy of lead-in silibinin and subsequent triple therapy in difficult-to-treat HIV/hepatitis C coinfected patients
Second Silibinin Workshop, Cologne, 23 rd May 2014 Efficacy of lead-in silibinin and subsequent triple therapy in difficult-to-treat HIV/hepatitis C coinfected patients Dominique L Braun, MD Division of
More informationRegister for e-mail notification of guideline updates at http://aidsinfo.nih.gov/e-news.
Recommendations for Use of Antiretroviral Drugs in Pregnant HIV-1-Infected Women for Maternal Health and Interventions to Reduce Perinatal HIV Transmission in the United States Visit the AIDSinfo website
More informationUK prevalence in pregnancy and risk of transmission
UK prevalence in pregnancy and risk of transmission In 2009 HIV prevalence in the UK among women giving birth was 2.2 per 1000 The majority of these women are from sub-saharan Africa with a prevalence
More informationHepatitis B co-infection among people living with HIV/AIDS in rural Tanzania
Hepatitis B co-infection among people living with HIV/AIDS in rural Tanzania Caroline Hvitmyhr Norunn Otterstrøm Prosjektoppgaven i medisinstudiet Medisinsk fakultet UNIVERSITETET I OSLO 10.03.2013 1 Abstract
More informationUpdate on Hepatitis C. Sally Williams MD
Update on Hepatitis C Sally Williams MD Hep C is Everywhere! Hepatitis C Magnitude of the Infection Probably 8 to 10 million people in the U.S. are infected with Hep C 30,000 new cases are diagnosed annually;
More informationEACS 2013. Dominique Braun Universitätsspital Zürich
EACS 2013 Switch data Rilpivirine: Swing-trial Elvitegravir: Flamingo-trial Simplification Dual-Therapy: LPV/r + 3TC in the Gardel-trial Mono-Therapy: Darunavir/r mono in clinical setting Boceprevir/Telaprevir
More informationAppendix 3 Exposure Incident Report Form
Appendix 3 Exposure Incident Report Form January, 2015 Page 1 of 6 Please see the following pages for the Exposure Incident Report Form. Guidelines for the Management of Exposure to Blood and Body Fluids
More informationPediatric HIV - The World At It's Best
VIH/SIDA en Pediatría: Epidemiología Mundial, Transmisión Perinatal, Manejo Integral. Juan Carlos Salazar, M.D. Universidad de Connecticut, EE.UU. End-1998 global estimates Children (
More informationBeginner's guide to Hepatitis C testing and immunisation against hepatitis A+B in general practice
Beginner's guide to Hepatitis C testing and immunisation against hepatitis A+B in general practice Dr Chris Ford GP & SMMGP Clinical Lead Kate Halliday Telford & Wrekin Shared Care Coordinator Aims Discuss:
More informationAASLD PRACTICE GUIDELINE UPDATE Chronic Hepatitis B: Update 2009
AASLD PRACTICE GUIDELINE UPDATE Chronic Hepatitis B: Update 2009 Anna S. F. Lok 1 and Brian J. McMahon 2 The 2009 update of the American Association for the Study of Liver Diseases (AASLD) Practice Guidelines
More informationClinical Application of HBs quantification
Clinical Application of HBs quantification Hepatology on the Nile 2 Advances in Liver Disease 2014, "World Expert Review» Wednesday, September 24, 2014 Pr Tarik Asselah MD, PhD; Service d Hépatologie &
More informationPOSTEXPOSURE PROPHYLAXIS
POSTEXPOSURE PROPHYLAXIS Bloodborne viruses Hepatitis B Hepatitis C HIV Hepatitis B Risk of seroconversion HBeAg negative 2% HBeAg positive 20-40% If seroconvert most recover completely and develop immunity
More informationDidactic Series. Updated Post-Exposure Prophylaxis (PEP) Guidelines. Daniel Lee, MD UCSD Medical Center, Owen Clinic January 9, 2014
Didactic Series Updated Post-Exposure Prophylaxis (PEP) Guidelines Daniel Lee, MD UCSD Medical Center, Owen Clinic January 9, 2014 ACCREDITATION STATEMENT: University of California, San Diego School of
More informationOUTLINE POST EXPOSURE PROPHYLAXIS (PEP) OCCUPATIONAL RISK OF VIRAL TRANSMISSION WITH SHARP INJURY FROM INFECTED SOURCE:
Professional needle stick accidents should be dealt with within 48 hours. An ARC (Aids Reference Centre) or an emergency department must be contacted as soon as possible. OUTLINE POST EXPOSURE PROPHYLAXIS
More informationROYAL HOSPITAL FOR WOMEN
HEPATITIS B POSITIVE MOTHERS AND THEIR BABIES This LOP is developed to guide clinical practice at the Royal Hospital for Women. Individual patient circumstances may mean that practice diverges from this
More informationResults Demographic profile of these children is shown in Table I.
Prevalence of Antibody to Hepatitis C Virus in Pakistani Thalassaemics by Particle Agglutination Test Utilizing C 200 and C 22-3 Viral Antigen Coated Particles Pages with reference to book, From 269 To
More informationManagement of non response or relapse following HCV therapy. Greg Dore Darrell Crawford
Management of non response or relapse following HCV therapy Greg Dore Darrell Crawford Learning objectives To understand importance of characterisation of prior HCV therapy response To explore options
More informationNational Health Burden of CLD in Italy
National Health Burden of CLD in Italy 11,000 deaths due to liver cirrhosis or HCC in 2006 Direct costs for the National Health System for treating CLD patients: 420 M / year for hospital care 164 M /
More informationCirrhosis and HCV. Jonathan Israel M.D.
Cirrhosis and HCV Jonathan Israel M.D. Outline Relationship of fibrosis and cirrhosisprevalence and epidemiology. Sequelae of cirrhosis Diagnosis of cirrhosis Effect of cirrhosis on efficacy of treatment
More informationHepatitis C. Eliot Godofsky, MD University Hepatitis Center Bradenton, FL
Hepatitis C Eliot Godofsky, MD University Hepatitis Center Bradenton, FL Recent Advances in Hepatitis C Appreciation that many patients are undiagnosed Improved screening to identify infected persons Assessment
More informationPhase: IV. Study Period: 20 Jan. 2006-17 Sep. 2008
The study listed may include approved and non-approved uses, formulations or treatment regimens. The results reported in any single study may not reflect the overall results obtained on studies of a product.
More informationViral Hepatitis. 2009 APHL survey report
Issues in Brief: viral hepatitis testing Association of Public Health Laboratories May Viral Hepatitis Testing 9 APHL survey report In order to characterize the role that the nation s public health laboratories
More informationReview: How to work up your patient with Hepatitis C
Review: How to work up your patient with Hepatitis C You screened your patient, and now the HCV antibody test is positive. What do you do next? The antibody test only means they have been exposed to HCV.
More informationLamivudine for Patients with hronic Hepatitis B and Advanced Liver Disease. From : New England Journal of Medicine
Lamivudine for Patients with hronic Hepatitis B and Advanced Liver Disease From : New England Journal of Medicine Volume 351:1521-1531, Number 15, Oct 7, 2004 馬 偕 紀 念 醫 院 一 般 內 科, 肝 膽 腸 胃 科 新 竹 分 院 陳 重
More informationChapter 36. Media Directory. Characteristics of Viruses. Primitive Structure of Viruses. Therapy for Viral Infections. Drugs for Viral Infections
Chapter 36 Media Directory Drugs for Viral Infections Slide 23 Slide 27 Slide 29 Zidovudine Animation Saquinavir Mesylate Animation Acyclovir Animation Upper Saddle River, New Jersey 07458 All rights reserved.
More informationCompany Overview March 2015
Company Overview March 2015 Disclaimer This presentation may contain forward-looking statements, including, without limitation, statements containing the words believes, expects, plans, estimates and similar
More informationViral load testing. medical monitoring: viral load testing: 1
medical monitoring: viral load testing: 1 medical monitoring: viral load testing Viral load testing medical monitoring: viral load testing: 2 Slide 1 Viral load The viral load test measures HIV in the
More informationHepatitis B and C What Is New In Perinatal Transmission?
Hepatitis B and C What Is New In Perinatal Transmission? Claudia M Espinosa, MD, MSc Pediatric Infectious Diseases University of Louisville July 28, 2015 Disclosure Statement I am a principal investigator
More informationCANADIAN CONSENSUS GUIDELINES. Management of chronic hepatitis B: Consensus guidelines
CANADIAN CONSENSUS GUIDELINES Management of chronic hepatitis B: Consensus guidelines Morris Sherman MD PhD 1, Stephen Shafran MD 2, Kelly Burak MD 3, Karen Doucette MD 2, Winnie Wong MD 2, Nigel Girgrah
More informationAcute viral hepatitis B (AVH-B) is successfully. A Randomized Controlled Trial of Lamivudine to Treat Acute Hepatitis B. Patients and Methods
A Randomized Controlled Trial of Lamivudine to Treat Acute Hepatitis B M. Kumar, S. Satapathy, R. Monga, K. Das, S. Hissar, C. Pande, B. C. Sharma, and S. K. Sarin The role of antivirals in patients with
More informationTG1050, A NOVEL IMMUNOTHERAPEUTIC TO TREAT CHRONIC HEPATITIS B, CAN CONTROL HBsAg AND PROVOKE HBsAg SEROCONVERSION IN HBV-PERSISTENT MOUSE MODELS
TG1050, A NOVEL IMMUNOTHERAPEUTIC TO TREAT CHRONIC HEPATITIS B, CAN CONTROL HBsAg AND PROVOKE HBsAg SEROCONVERSION IN HBV-PERSISTENT MOUSE MODELS Karine Lélu 1, Alexei Evlachev 1, Roland Kratzer 1, Sarah
More informationFrequently Asked Questions (FAQs)
Frequently Asked Questions (FAQs) Research Rationale 1. What does PrEP stand for? There is scientific evidence that antiretroviral (anti-hiv) medications may be able to play an important role in reducing
More informationGUIDELINES FOR VIRAL HEPATITIS SURVEILLANCE AND CASE MANAGEMENT
GUIDELINES FOR VIRAL HEPATITIS SURVEILLANCE AND CASE MANAGEMENT January 2005 Guidelines for Viral Hepatitis Surveillance and Case Management Ordering information To order a copy of this manual, write to:
More informationNON-OCCUPATIONAL POST EXPOSURE PROPHYLAXIS FOR SEXUAL ASSAULT SURVIVORS. Carl LeBuhn, MD
NON-OCCUPATIONAL POST EXPOSURE PROPHYLAXIS FOR SEXUAL ASSAULT SURVIVORS Carl LeBuhn, MD Post-Exposure Prophylaxis (PEP) The use of therapeutic agents to prevent infection following exposure to a pathogen
More informationWhat is HIV? What is AIDS? The HIV pandemic HIV transmission Window period Stages of HIV infection
Module 1 Overview of HIV Infection Purpose Pre-requisite Modules Learning Objectives To provide you with the basic terms and concepts related to HIV infection. None At the end of this module, you will
More informationBriefing Note: Hepatitis B & Hepatitis C. Summary:
Briefing Note: Hepatitis B & Hepatitis C Summary: In Canada, hepatitis B and hepatitis C infections remain serious public health concerns due to high prevalence rates, high health care expenditures and
More informationEPIDEMIOLOGY OF HEPATITIS B IN IRELAND
EPIDEMIOLOGY OF HEPATITIS B IN IRELAND Table of Contents Acknowledgements 3 Summary 4 Introduction 5 Case Definitions 6 Materials and Methods 7 Results 8 Discussion 11 References 12 Epidemiology of Hepatitis
More informationUPDATE IN HIV POST-EXPOSURE PROPHYLAXIS. Weerawat Manosuthi
UPDATE IN HIV POST-EXPOSURE PROPHYLAXIS Weerawat Manosuthi Outline Case scenario of postexposure prophylaxis Risks of and how to manage postexposure prophylaxis Current PEP guideline US PHS 2013 New York
More informationCANADIAN CONSENSUS GUIDELINES. Management of chronic hepatitis B: Consensus guidelines
CANADIAN CONSENSUS GUIDELINES Management of chronic hepatitis B: Consensus guidelines Morris Sherman MD PhD 1, Stephen Shafran MD 2, Kelly Burak MD 3, Karen Doucette MD 2, Winnie Wong MD 2, Nigel Girgrah
More informationCommonly Asked Questions About Chronic Hepatitis C
Commonly Asked Questions About Chronic Hepatitis C From the American College of Gastroenterology 1. How common is the hepatitis C virus? The hepatitis C virus is the most common cause of chronic viral
More information