Recommendations 8/14/2014. Hepatitis C Clinical Approach Primary Care. Purpose of Presentation. HCV Prevalence Year of Birth

Size: px
Start display at page:

Download "Recommendations 8/14/2014. Hepatitis C Clinical Approach Primary Care. Purpose of Presentation. HCV Prevalence Year of Birth"

Transcription

1 Hepatitis C Clinical Approach Primary Care Dr. Vicki L. MIt McIntyre, FNP Tucson Gastroenterology Specialists Tucson, Arizona University of Phoenix Lead Faculty, Department of Nursing Tucson, Arizona Purpose of Presentation Establish competence in screening and diagnosing of persons with hepatitis C (HCV) infection. Summarize HCV testing sequence for identifying current infection. Recognize and diagnose persons with chronic HCV infection. Summarize the natural history of persons with chronic HCV infection. Provide appropriate counseling to patients for preventing further liver insults. Conduct hepatocellular carcinoma surveillance when indicated. Provide management strategies for person with chronic HCV infection Increase awareness of future therapies available for treatment of HCV. HCV Prevalence Estimate in U.S. Source: Chak e, et al, Liver Inst 2011;31: HCV Prevalence Year of Birth CDC HCV Testing CDC HCV Testing Recommendations Source: Armstrong GL, et al. Ann Intern Med. 2006;

2 CDC HCV Testing CDC HCV Testing Recommendations 2012 CDC Birth Cohort HCV Testing Recommendations Source: CDC and Prevention. MMWR RR61:1 32. Estimated Prevalence Chronic HCV in U.S. Rationale for Birth Cohort HCV Testing Recommendations Source: Armstrong GL, et al. Ann Intern Med. 2006; Chak e, et al, Liver Inst 2011;31: Age Adjusted Mortality Rates from HBV, HCV, & HIV U.S Forecasted Annual HCV Related Deaths U.S. Chronic HCV and no Cirrhosis in 2005 Source: Ly KN, et al. Ann Intern Med.2012:156: Source: Rein DR, et al. Dig Liver Dis.2011:43:

3 Forecasted Annual HCV Related Deaths U.S. Chronic HCV and no Cirrhosis in 2005 Burden of Disease Related to HCV Expected to triple in next years Source: Rein DR, et al. Dig Liver Dis.2011:43: Source: WHO Hepatitis C Fact Sheet HCV Treatment: Historical Milestones HCV Treatment Cure Rates HCV Testing Birth Cohort Projected Benefit of One Time Testing Goals for Birth Cohort HCV Testing in U.S. Source: Rein DB, et al. Ann Intern Med.2012:156:

4 Testing Sequence HCV Testing Sequence Testing Sequence Testing Sequence Testing Sequence Testing Sequence 4

5 Testing Sequence CDC Recommendations for Post Test Counseling HCV Infection: Post Test Counseling Messages HCV Survival in Syringes HCV survives for up to 63 days in syringes Lower survival in insulin syringes than tuberculin syringes Source: Paintsil E, et al, J Infect Dise.2010:202: HCV Survival in Bottled Water Heterosexual Transmission of HCV Monogamous Serodiscordant Couples HCV survives for up to 3 weeks in bottled water Source: Doerrbecker J, et al. J Infect Dis, 2013:207: Source: Vandelli C, et al. Am J Gastroenterol.2004;99:

6 Heterosexual Transmission of HCV Monogamous Serodiscordant Couples HCV Survival Outside the Body Source: Vandelli C, et al. Am J Gastroenterol.2004;99: Source: Ciesek S et al. J Infect Dis.2010;201: Preventing Household Transmission HCV Mother to Child Transmission HVC Annual births with HCV infected mothers: estimated at 40,000 Risk of Transmission i from mother to child: 3 10% Source: CDC and Prevention, Division of Viral Hepatitis Source: CDC and Prevention, Division of Viral Hepatitis Alcohol Alcohol Use >48 g/day associated: increased risk of cirrhosis, liver cancer, mortality Alcohol Use and HCV Synergistic effect >50 g/day or > 5 drinks/day: increased fibrosis Light and moderate also with an effect Degree of fibrosis correlates with degree of use <31 g/day probability of increased fibrosis Cannabis Biologic Effects Cannabinoid receptor types 1 and 2 regulate progression of experimental liver fibrosis Use is associated with liver disease Daily cannabis use associated: higher risk of moderate to severe liver fibrosis Combination moderate/heavy ETOH use associated with even greater risk of fibrosis Should be discouraged in HCV infection 6

7 OTC, Complementary, Alternative Medications CDC Additional Messages Over the counter Limit acetaminophen to 2 g/day, 1g/day in cirrhosis Avoid NSAIDs in cirrhosis Avoid Fe supplementation (unless Fe deficiency anemia present) Complementary and alternative medicines Insufficient evidence to support their use Source: CDC and Prevention, Division of Viral Hepatitis Physical Exam Findings in Chronic Liver Disease Initial Evaluation Chronic Hepatitis C Physical Examination Laboratory Studies After Initial Diagnosis General Hepatic profile CBC/diff CMP Disease related Imaging Determine liver damage Liver biopsy Noninvasive markers FibroSure, etc. 7

8 Laboratory Studies Liver Tests Laboratory Studies After Initial Diagnosis Liver Enzymes AST ALT Alkaline Phosphatase GGT Liver Synthetic Tests TRUE LIVER FUNCTION TESTS Bilirubin Albumin Protime/INR Platelets Immunizations Assessment: Alcohol Use Disorder Assessment: Alcohol Use Disorder HCV Infection Natural History 8

9 Natural History of Hepatitis C Infection Natural History of Hepatitis C Infection Progression of HCV is Variable GROSS IMAGE: NORMAL AND A CIRRHOTIC LIVER Normal Liver Cirrhotic Liver Irregular surface Evaluation and Staging of Liver Fibrosis Nodules 9

10 Staging of Liver Disease Scoring: Histologic Stage (Fibrosis) Abbreviation: International Association for Study of the Liver (IASL) Clinical Outcomes of Cirrhosis Evaluation and Prognosis HCV Cirrhosis Survival: Compensated vs Decompensated Cirrhosis Cirrhosis Classification System 10

11 Natural History of End Stage Liver Disease (ESLD) Natural History of ESLD Transition to decompensated cirrhosis 5% to 7% patients per year Hepatocellular carcinoma Can trigger decompensation Predictor of death in decompensated cirrhosis Tools: Predicting disease severity/death (decompensated cirrhosis) Child Turcotte Pugh (CTP) score Model for End Stage Liver Disease (MELD) score Variceal Surveillance Endoscopic View Esophageal Varices Prophylaxis Variceal Bleeding Variceal 11

12 Variceal Hemmorhage ESLD AND HCV ALL patients with cirrhosis require monitoring for Varices with EGD HCC surveillance: imaging and alpha fetoprotein Ascites and infection Jaundice Surveillance for Hepatocellular Carcinoma Hepatocellular Carcinoma Surveillance Hepatocellular Carcinoma Risk All patients with cirrhosis require monitoring Ultrasound first line CT or MRI if lesion found Alpha fetoprotein (AFP).. Many treatment modalities depending upon size and number of lesions 12

13 2008 Global Cancer Deaths Hepatocellular Carcinoma (HCC) HCV Extra hepatic Manifestations HCV Extra hepatic Manifestations Hematologic Mixed cryoglobulinemia Aplastic anemia Thrombocytopenia Non-Hodgkin s -cell lymphoma Dermatologic Porphyria cutanea tarda Lichen planus Cutaneous necrotizing vasculitis Renal Glomerulonephritis Nephrotic syndrome Endocrine Anti-thyroid antibodies Diabetes mellitus Hadziyannis SJ. J Eur Acad Dermatol Venereol. 1998;10: Ocular Corneal ulcer Uveitis Vascular Necrotizing vasculitis Polyarteritis nodosa Neuromuscular Weakness/myalgia Peripheral neuropathy Arthritis/arthralgia Autoimmune Phenomena CREST syndrome Salivary Sialadenitis HCV Extra hepatic Manifestations Ascites 13

14 Management of Ascites Ascites Hepatic Encephalopathy (HE) Hepatic Encephalopathy Source: Bajaj JS. Aliment Pharmaco Ther. 2010; Hepatic Encephalopathy Mental State Grading West Haven Criteria 14

15 Goals for Liver Transplantation Referral for Liver Transplantation Cirrhosis and Liver Transplantation Liver Transplants Source: Smith BD et al. MMWR Recomm. Rep.2012:61(RR 4):1 32. Rationale and Goals for Treatment Chronic HCV is a progressive disease HCV Treatment Can produce significant morbidity and mortality if left untreated 15

16 Treatment Reduces Liver Related Complications HCV Treatment Cure of HCV achievable Sustained Virological Response (SVR) SVR associated with significant clinical benefit Slows or reverse disease progression Reduces hepatic and all cause mortality Improves extra hepatic manifestations Projected New HCV Treatment Agents Five Clinical Practice Points Screen for HCV infection Identify and Educate person with HCV infection Assessment of HCV disease progression Rf Referral lfor appropriate it care Cirrhosis decompensated and decompensated Treatment cure Clinical Management Cirrhosis semi yearly for HHC surveillance/disease progression Non cirrhosis yearly for disease progression Thank you!. Questions? 16

After the Cure: Long-Term Management of HCV Liver Disease Norah A. Terrault, MD, MPH

After the Cure: Long-Term Management of HCV Liver Disease Norah A. Terrault, MD, MPH After the Cure: Long-Term Management of HCV Liver Disease Norah A. Terrault, MD, MPH Professor of Medicine Department of Gastroenterology Director, Viral Hepatitis Center University of California San Francisco

More information

Patterns of abnormal LFTs and their differential diagnosis

Patterns of abnormal LFTs and their differential diagnosis Patterns of abnormal LFTs and their differential diagnosis Professor Matthew Cramp South West Liver Unit and Peninsula Schools of Medicine and Dentistry, Plymouth Summary liver function / liver function

More information

Cirrhosis and HCV. Jonathan Israel M.D.

Cirrhosis 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 information

Hepatitis C Treatment Criteria Commercial & Minnesota Health Care Programs

Hepatitis C Treatment Criteria Commercial & Minnesota Health Care Programs Last update: February 23, 2015 Hepatitis C Treatment Criteria Commercial & Minnesota Health Care Programs Please see healthpartners.com for Medicare coverage criteria. Table of Contents 1. Harvoni 2. Sovaldi

More information

Recommendations for the Identification of Chronic Hepatitis C virus infection Among Persons Born During 1945-1965

Recommendations for the Identification of Chronic Hepatitis C virus infection Among Persons Born During 1945-1965 Recommendations for the Identification of Chronic Hepatitis C virus infection Among Persons Born During 1945-1965 MMWR August 17, 2012 Prepared by : The National Viral Hepatitis Technical Assistance Center

More information

Evaluation and Prognosis of Patients with Cirrhosis

Evaluation and Prognosis of Patients with Cirrhosis Evaluation and Prognosis of Patients with Cirrhosis Marion G. Peters, MD John V. Carbone, MD, Endowed Chair Professor of Medicine Chief of Hepatology Research University of California San Francisco Recorded

More information

A New Era in Hepatitis C Therapy: A Public Health Problem with Solutions

A New Era in Hepatitis C Therapy: A Public Health Problem with Solutions A New Era in Hepatitis C Therapy: A Public Health Problem with Solutions Hemant Shah MD MScCH HPTE Clinic and Education Director Francis Family Liver Clinic @ TWH University of Toronto Disclosures Consulting

More information

New IDSA/AASLD Guidelines for Hepatitis C

New IDSA/AASLD Guidelines for Hepatitis C NORTHWEST AIDS EDUCATION AND TRAINING CENTER New IDSA/AASLD Guidelines for Hepatitis C John Scott, MD, MSc Associate Professor, UW SoM Asst Director, Liver Clinic, Harborview Medical Center Presentation

More information

Hepatitis C Treatment Expansion Initiative Multi-Site Conference Call. March 16, 2011

Hepatitis C Treatment Expansion Initiative Multi-Site Conference Call. March 16, 2011 Hepatitis C Treatment Expansion Initiative Multi-Site Conference Call March 16, 2011 Case Presentations Kansas City Free Health Clinic Carilion Clinic Didactic Session Challenges in Determining HCV Treatment

More information

Transmission of HCV in the United States (CDC estimate)

Transmission 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 information

Update on Hepatitis C. Sally Williams MD

Update 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 information

Review: How to work up your patient with Hepatitis C

Review: 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 information

Hepatitis C: Epidemiology, Transmission, and Screening. Jennifer Price, MD Assistant Professor of Medicine University of California San Francisco

Hepatitis C: Epidemiology, Transmission, and Screening. Jennifer Price, MD Assistant Professor of Medicine University of California San Francisco Activity Code FA376 Hepatitis C: Epidemiology, Transmission, and Screening Jennifer Price, MD Assistant Professor of Medicine University of California San Francisco Learning Objectives Upon completion

More information

Surveillance for Hepatocellular Carcinoma

Surveillance for Hepatocellular Carcinoma Surveillance for Hepatocellular Carcinoma Marion G. Peters, MD John V. Carbone, MD, Endowed Chair Professor of Medicine Chief of Hepatology Research University of California San Francisco Recorded on April

More information

A 55 year old man with cirrhosis due to chronic hepatitis C (CHC) genotype 3a is referred for liver transplantation.

A 55 year old man with cirrhosis due to chronic hepatitis C (CHC) genotype 3a is referred for liver transplantation. A 55 year old man with cirrhosis due to chronic hepatitis C (CHC) genotype 3a is referred for liver transplantation. Three years ago he was treated with 24 weeks of peginterferon alfa-2a (180 µg/wk, PEGIFN)

More information

Sovaldi (sofosbuvir) Prior Authorization Criteria

Sovaldi (sofosbuvir) Prior Authorization Criteria INITIAL REVIEW CRITERIA Sovaldi (sofosbuvir) Prior Authorization Criteria 1. Adult patient age 18 years old; AND 2. Prescribed by a hepatologist, gastroenterologist, infectious disease specialist, transplant

More information

The following should be current within the past 6 months:

The following should be current within the past 6 months: EVALUATION Baseline Labs Obtain at time or prior to initial evaluation CBC with diff PT/INR CMP HCV Genotype (obtained PRIOR TO consult visit) HCV RNA (obtained PRIOR TO consult visit) Hep A IgG Hep BsAg,

More information

Hepatitis C Infections in Oregon September 2014

Hepatitis C Infections in Oregon September 2014 Public Health Division Hepatitis C Infections in Oregon September 214 Chronic HCV in Oregon Since 25, when positive laboratory results for HCV infection became reportable in Oregon, 47,252 persons with

More information

What to Do with the Patient With Abnormal Liver Enzymes? Nizar N. Zein, M.D. The Cleveland Clinic

What to Do with the Patient With Abnormal Liver Enzymes? Nizar N. Zein, M.D. The Cleveland Clinic What to Do with the Patient With Abnormal Liver Enzymes? Nizar N. Zein, M.D. The Cleveland Clinic Introduction Elevated liver enzymes is often not a clinical problem by itself. However it is a warning

More information

PREVENTION OF HCC BY HEPATITIS C TREATMENT. Morris Sherman University of Toronto

PREVENTION OF HCC BY HEPATITIS C TREATMENT. Morris Sherman University of Toronto PREVENTION OF HCC BY HEPATITIS C TREATMENT Morris Sherman University of Toronto Pathogenesis of HCC in chronic hepatitis C Injury cirrhosis HCC Injury cirrhosis HCC Time The Ideal Study Prospective randomized

More information

Strategies to Improve the HCV Continuum of Care:

Strategies to Improve the HCV Continuum of Care: Strategies to Improve the HCV Continuum of Care: Best Practices in Testing, Linkage to Care & Treatment Ronald O. Valdiserri, M.D., M.P.H. Deputy Assistant Secretary for Health, Infectious Diseases June

More information

Commonly Asked Questions About Chronic Hepatitis C

Commonly 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

Lamivudine 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 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 information

PRIOR AUTHORIZATION PROTOCOL FOR HEPATITIS C TREATMENT

PRIOR AUTHORIZATION PROTOCOL FOR HEPATITIS C TREATMENT PRIOR AUTHORIZATION PROTOCOL FOR HEPATITIS C TREATMENT HARVONI (90mg ledipasvir/400mg sofosbuvir): tablet (PREFERRED AGENT) SOVALDI (sofosbuvir ): 400mg tablets (PREFERRED AGENT ) OLYSIO (simeprivir) PEG-INTRON

More information

Liver Transplantation for Hepatocellular Carcinoma. John P. Roberts, MD Chief, Division of Transplant Service University of California, San Francisco

Liver Transplantation for Hepatocellular Carcinoma. John P. Roberts, MD Chief, Division of Transplant Service University of California, San Francisco Liver Transplantation for Hepatocellular Carcinoma John P. Roberts, MD Chief, Division of Transplant Service University of California, San Francisco Hepatocellular Carcinoma HCC is the 5th most common

More information

Hepatitis Update. HCV Cure As A Paradigm for Convergence of Interests. Evidence Based Nuts and Bolts For the Family Doc 11/5/2014

Hepatitis Update. HCV Cure As A Paradigm for Convergence of Interests. Evidence Based Nuts and Bolts For the Family Doc 11/5/2014 Evidence Based Nuts and Bolts For the Family Doc Hepatitis Update William Carey MD MACG, FAASLD Oct 25, 2014 HCV Cure As A Paradigm for Convergence of Interests Hepatitis C Cure 1 Get Ready Get SET Go

More information

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 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 information

HCV Epidemiology in the United States

HCV Epidemiology in the United States HCV Epidemiology in the United States Scott Holmberg, MD, MPH Chief, Epidemiology and Surveillance Branch, DVH, CDC sdh1@cdc.gov A Tale of Two Epidemics Chronic HCV: Rapidly increasing mortality and morbidity

More information

Acute on Chronic Liver Failure: Current Concepts. Disclosures

Acute on Chronic Liver Failure: Current Concepts. Disclosures Acute on Chronic Liver Failure: Current Concepts Vandana Khungar, MD MSc Assistant Professor of Medicine University of Pennsylvania, Perelman School of Medicine September 20, 2015 None to declare Disclosures

More information

LCD for Viral Hepatitis Serology Tests

LCD for Viral Hepatitis Serology Tests LCD for Viral Hepatitis Serology Tests Applicable CPT Code(s): 86692 Antibody; Hepatitis, Delta Agent 86704 Hepatitis B Core Antibody (HBcAb); Total 86705 Hepatitis B Core Antibody (HBcAb); IgM Antibody

More information

Management of hepatitis C: pre- and post-liver transplantation. Piyawat Komolmit Bangkok

Management of hepatitis C: pre- and post-liver transplantation. Piyawat Komolmit Bangkok Management of hepatitis C: pre- and post-liver transplantation Piyawat Komolmit Bangkok Liver transplantation and CHC Cirrhosis secondary to HCV is the leading cause of liver transplantation in the US

More information

NP/PA Clinical Hepatology Fellowship Summary of Year-Long Curriculum

NP/PA Clinical Hepatology Fellowship Summary of Year-Long Curriculum OVERVIEW OF THE FELLOWSHIP The goal of the AASLD NP/PA Fellowship is to provide a 1-year postgraduate hepatology training program for nurse practitioners and physician assistants in a clinical outpatient

More information

MANAGEMENT OF LIVER CIRRHOSIS

MANAGEMENT OF LIVER CIRRHOSIS MANAGEMENT OF LIVER CIRRHOSIS Information Leaflet Your Health. Our Priority. Page 2 of 6 What is cirrhosis? Cirrhosis is a result of long-term, continuous damage to the liver and may be due to many different

More information

BURDEN OF LIVER DISEASE IN BRAZIL

BURDEN OF LIVER DISEASE IN BRAZIL BURDEN OF LIVER DISEASE IN BRAZIL Burden of Liver Disease in Europe Blachier et al. J Hepatol 58:593, 2013 Review of 260 epidemiologic studies of the 5 previous years Cirrhosis is responsible for 170.000

More information

HIV/HCV Co-infection. HIV/HCV Co-infection. Epidemiology. Dr Ranjababu Kulasegaram Guy s & St Thomas Hospital London. Extrahepatic manifestations

HIV/HCV Co-infection. HIV/HCV Co-infection. Epidemiology. Dr Ranjababu Kulasegaram Guy s & St Thomas Hospital London. Extrahepatic manifestations HIV/HCV Co-infection Dr Ranjababu Kulasegaram Guy s & St Thomas Hospital London HIV/HCV Co-infection Epidemiology Impact of HIV on HCV Epidemiology Impact of HCV on HIV Management issues Future Extrahepatic

More information

CANCER OF THE LIVER HEPATOCELLULAR CARCINOMA

CANCER OF THE LIVER HEPATOCELLULAR CARCINOMA CANCER OF THE LIVER HEPATOCELLULAR CARCINOMA WHAT IS CANCER OF THE LIVER? Hepatocellular carcinoma is the most common form and it comes from the main type of liver cell, the hepatocyte. About 3 out 4

More information

DENOMINATOR: All patients aged 18 years and older with a diagnosis of chronic hepatitis C cirrhosis

DENOMINATOR: All patients aged 18 years and older with a diagnosis of chronic hepatitis C cirrhosis Measure #401: Hepatitis C: Screening for Hepatocellular Carcinoma (HCC) in Patients with Cirrhosis National Quality Strategy Domain: Effective Clinical Care 2016 PQRS OPTIONS FOR INDIVIDUAL MEASURES: REGISTRY

More information

3/25/2014. April 3, 2014. Dennison MM, et al. Ann Intern Med. 2014;160:293 300.

3/25/2014. April 3, 2014. Dennison MM, et al. Ann Intern Med. 2014;160:293 300. April 3, 2014 3.6 million persons ever infected; 2.7 million chronic infections 1 Up to 75% unaware of status Transmitted through percutaneous exposure to infected blood Injection drug use (IDU) is the

More information

HEPATITIS C THERAPY PRIOR AUTHORIZATION FORM: Page 1 of 3 Patient Information. Diagnosis Acute Hep C Chronic Hep C Hepatocellular Carcinoma

HEPATITIS C THERAPY PRIOR AUTHORIZATION FORM: Page 1 of 3 Patient Information. Diagnosis Acute Hep C Chronic Hep C Hepatocellular Carcinoma HEPATITIS C THERAPY PRIOR AUTHORIZATION FORM: Page 1 of 3 Patient Information Recipient: MA#: Date of Birth: Phone #: Body Weight: Treatment Plan Sovaldi (sofosbuvir) 400mg: Take once daily for weeks Olysio

More information

Primary Care for Hepatitis B and C:

Primary Care for Hepatitis B and C: Primary Care for Hepatitis B and C: Clinical Tools for Efficient Management Rena K. Fox, M.D. Associate Professor of Clinical Medicine University of California, San Francisco Outline 1. Epidemiology of

More information

Boston Healthcare for the Homeless Program Primary Care Guideline for the Care of Patients with Chronic Hepatitis C

Boston Healthcare for the Homeless Program Primary Care Guideline for the Care of Patients with Chronic Hepatitis C Boston Healthcare for the Homeless Program Primary Care Guideline for the Care of Patients with Chronic Hepatitis C Rationale for Hepatitis C (HCV) Guideline: HCV is a highly prevalent infection in the

More information

Chronic Hepatitis C Virus (Chronic HCV)

Chronic Hepatitis C Virus (Chronic HCV) Chronic Hepatitis C Virus (Chronic HCV) Amie Baumgartner PA-C Fall 2015 Purpose of Lecture! Educate Gastroenterology nurses about Hepatitis C and its treatment in order to improve their knowledge and confidence

More information

Case Finding for Hepatitis B and Hepatitis C

Case 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 information

LIVER FUNCTION TESTS AND STATINS

LIVER FUNCTION TESTS AND STATINS LIVER FUNCTION TESTS AND STATINS Philippe J. Zamor and Mark W. Russo Current Opinion in Cardiology 2011,26:338 341 SUMMARY Purpose of review: To discuss recent data on statins in patients with elevated

More information

Albumin. Prothrombin time. Total protein

Albumin. Prothrombin time. Total protein Hepatitis C Fact Sheet February 2016 www.hepatitis.va.gov Laboratory Tests and Hepatitis If you have hepatitis C, your doctor will use laboratory tests to about learn more about your individual hepatitis

More information

Hepatitis C Second Generation Antivirals (Harvoni, Technivie TM, Viekira Pak ) Prior Authorization - Through Preferred Agent(s) Program Summary

Hepatitis C Second Generation Antivirals (Harvoni, Technivie TM, Viekira Pak ) Prior Authorization - Through Preferred Agent(s) Program Summary Hepatitis C Second Generation Antivirals (Harvoni, Technivie TM, Viekira Pak ) Prior Authorization - Through Preferred Agent(s) Program Summary This program applies to Health Insurance Marketplace, FlexRx

More information

Hepatitis C Glossary of Terms

Hepatitis C Glossary of Terms Acute Hepatitis C A short-term illness that usually occurs within the first six months after someone is exposed to the hepatitis C virus (HCV). 1 Antibodies Proteins produced as part of the body s immune

More information

Ledipasvir/Sofosbuvir (Harvoni) for Treatment of Hepatitis C

Ledipasvir/Sofosbuvir (Harvoni) for Treatment of Hepatitis C Ledipasvir/Sofosbuvir (Harvoni) for Treatment of Hepatitis C Policy Number: Original Effective Date: MM.04.034 12/1/2014 Line(s) of Business: Current Effective Date: HMO; PPO; QUEST Integration 12/1/2014

More information

HEPATITIS WEB STUDY Acute Hepatitis C Virus Infection: Epidemiology, Clinical Features, and Diagnosis

HEPATITIS 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 information

HCV/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 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 information

Boehringer Ingelheim- sponsored Satellite Symposium. HCV Beyond the Liver

Boehringer Ingelheim- sponsored Satellite Symposium. HCV Beyond the Liver Boehringer Ingelheim- sponsored Satellite Symposium HCV Beyond the Liver HCV AS A METABOLIC MODIFIER: STEATOSIS AND INSULIN RESISTANCE Francesco Negro University Hospital of Geneva Switzerland Clinical

More information

An Approach to the Diagnosis and Treatment of Hepatitis C Virus Infection in 2015. Matthew McMahon, MD

An Approach to the Diagnosis and Treatment of Hepatitis C Virus Infection in 2015. Matthew McMahon, MD An Approach to the Diagnosis and Treatment of Hepatitis C Virus Infection in 2015 Matthew McMahon, MD In the United States, 2.2-3.2 million people are infected with the hepatitis C virus (HCV) Half unaware

More information

Approach to Abnormal Liver Tests

Approach to Abnormal Liver Tests Approach to Abnormal Liver Tests Naga P. Chalasani, MD, FACG Professor of Medicine and Cellular & Integrative Physiology Director, Division of Gastroenterology and Hepatology Indiana University School

More information

Hepatocellular Carcinoma (HCC)

Hepatocellular Carcinoma (HCC) Abhishek Vadalia Introduction Chemoembolization is being used with increasing frequency in the treatment of solid hepatic tumors such as Hepatocellular Carinoma (HCC) & rare Cholangiocellular Carcinoma

More information

Hepatitis C Virus Infection in Massachusetts: A tale of two epidemics

Hepatitis C Virus Infection in Massachusetts: A tale of two epidemics Hepatitis C Virus Infection in Massachusetts: A tale of two epidemics Daniel Church, MPH Massachusetts Department of Public Health Bureau of Infectious Disease 1 Goals of presentation Provide an overview

More information

Hepatitis 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 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 information

Epidemiology of Hepatitis C Infection. Pablo Barreiro Service of Infectious Diseases Hospital Carlos III, Madrid

Epidemiology of Hepatitis C Infection. Pablo Barreiro Service of Infectious Diseases Hospital Carlos III, Madrid Epidemiology of Hepatitis C Infection Pablo Barreiro Service of Infectious Diseases Hospital Carlos III, Madrid Worldwide Prevalence of Hepatitis C 10% No data available WHO.

More information

LIVER TUMORS PROFF. S.FLORET

LIVER TUMORS PROFF. S.FLORET LIVER TUMORS PROFF. S.FLORET NEOPLASM OF LIVER PRIMARY 1)BENIGN 2)MALIGNANT METASTATIC/SECONDARY LIVER Primary Liver Cancer the Second Killer among tumors high morbidity and mortality(20.40/100,000) etiology

More information

The State of the Liver in the Adult Patient after Fontan Palliation

The State of the Liver in the Adult Patient after Fontan Palliation The State of the Liver in the Adult Patient after Fontan Palliation Fred Wu, M.D. Boston Adult Congenital Heart Service Boston Children s Hospital/Brigham & Women s Hospital 7 th National Adult Congenital

More information

Evaluation of abnormal LFT in the asymptomatic patient. Son Do, M.D. Advanced Gastroenterology Vancouver, WA

Evaluation of abnormal LFT in the asymptomatic patient. Son Do, M.D. Advanced Gastroenterology Vancouver, WA Evaluation of abnormal LFT in the asymptomatic patient Son Do, M.D. Advanced Gastroenterology Vancouver, WA Definition of chronic, abnormally elevated LFT Elevation of one or more of the following for

More information

Alcoholic Hepatitis (Teacher s Guide)

Alcoholic Hepatitis (Teacher s Guide) Thomas Ormiston, M.D. Updated 5/5/15 2007-2015, SCVMC Alcoholic Hepatitis (Teacher s Guide) (30 minutes) I. Objectives Recognize the signs and symptoms of alcoholic hepatitis Understand the treatment options

More information

National Hepatitis C Database for infection acquired through blood and blood products

National Hepatitis C Database for infection acquired through blood and blood products National Hepatitis C Database for infection acquired through blood and blood products for infection acquired through blood and blood products 2010 Report National Hepatitis C Database for infection acquired

More information

Clinical Criteria for Hepatitis C (HCV) Therapy

Clinical Criteria for Hepatitis C (HCV) Therapy Diagnosis Clinical Criteria for Hepatitis C (HCV) Therapy Must have chronic hepatitis C, genotype and sub-genotype specified to determine the length of therapy; Liver biopsy or other accepted test demonstrating

More information

Placing Nation on the Path Toward the Elimination of Hepatitis C

Placing Nation on the Path Toward the Elimination of Hepatitis C Placing Nation on the Path Toward the Elimination of Hepatitis C John W. Ward, M.D. Division of Viral Hepatitis Centers for Disease Control and Prevention Division of Viral Hepatitis National Center for

More information

Disclosure of Conflicts of Interest Learner Assurance Statement:

Disclosure of Conflicts of Interest Learner Assurance Statement: Raj Reddy, MD Ruimy Family President's Distinguished Professor of Medicine Professor of Medicine in Surgery Director of Hepatology Director, Viral Hepatitis Center Medical Director, Liver Transplantation

More information

Peg-IFN and ribavirin: what sustained virologic response can be achieved by using HCV genotyping and viral kinetics?

Peg-IFN and ribavirin: what sustained virologic response can be achieved by using HCV genotyping and viral kinetics? Peg-IFN and ribavirin: what sustained virologic response can be achieved by using HCV genotyping and viral kinetics? Prof. I. Bakulin Gastroenterology Department Key Questions Background Worldwide prevalence

More information

Leading the Way to Treat Liver Cancer

Leading the Way to Treat Liver Cancer Leading the Way to Treat Liver Cancer Guest Expert: Sukru, MD Professor of Transplant Surgery Mario Strazzabosco, MD Professor of Internal Medicine www.wnpr.org www.yalecancercenter.org Welcome to Yale

More information

End Stage Liver Disease: What is New? Marion Peters MD UCSF Berlin 2012

End Stage Liver Disease: What is New? Marion Peters MD UCSF Berlin 2012 End Stage Liver Disease: What is New? Marion Peters MD UCSF Berlin 2012 Natural History of ESLD Increasing liver fibrosis Development of HCC Chronic liver disease Compensated cirrhosis Decompensated cirrhosis

More information

Hepatitis C. Laboratory Tests and Hepatitis C

Hepatitis C. Laboratory Tests and Hepatitis C Hepatitis C Laboratory Tests and Hepatitis C If you have hepatitis C, your doctor will use laboratory tests to check your health. This handout will help you understand what the major tests are and what

More information

Information about hepatitis C for patients and carers

Information about hepatitis C for patients and carers Information about hepatitis C for patients and carers What is hepatitis C? Hepatitis C is an illness caused by a virus which can be passed through blood from one person to another. It mainly affects the

More information

PRINCESS MARGARET CANCER CENTRE CLINICAL PRACTICE GUIDELINES

PRINCESS MARGARET CANCER CENTRE CLINICAL PRACTICE GUIDELINES PRINCESS MARGARET CANCER CENTRE CLINICAL PRACTICE GUIDELINES GASTROINTESTINAL HEPATOCELLULAR CARCINOMA GI Site Group Hepatocellular Carcinoma Authors: Dr. Jennifer Knox, Dr. Mairead McNamara 1. INTRODUCTION

More information

Hepatitis C in 2015. Primary Care Providers: Linkage to Care

Hepatitis C in 2015. Primary Care Providers: Linkage to Care Hepatitis C in 2015 Primary Care Providers: Linkage to Care Michael D Voigt Medical Director, Liver Failure and Transplantation University of Iowa, Hospitals and Clinics Disclosures I have NO disclosures

More information

KY Hepatitis Connections

KY Hepatitis Connections KY Hepatitis Connections Greetings partners and colleagues! March is here and spring is right around the corner. I have settled into my new role and have received input from many of you related to the

More information

Therapy of decompensated cirrhosis Pre-transplant for HBV and HCV

Therapy of decompensated cirrhosis Pre-transplant for HBV and HCV Therapy of decompensated cirrhosis Pre-transplant for HBV and HCV Universitätsklinikum Leipzig Thomas Berg Sektion Hepatologie Klinik und Poliklinik für Gastroenterologie und Rheumatologie Leber- und Studienzentrum

More information

National Health Burden of CLD in Italy

National 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 information

Preface. TTY: (888) 232-6348 or cdcinfo@cdc.gov. Hepatitis C Counseling and Testing, contact: 800-CDC-INFO (800-232-4636)

Preface. 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 information

NASH: It is not JUST a Fatty Liver. Karen F. Murray, M.D. Director of Hepatobiliary Program Children s Hospital and Regional Medical Center

NASH: It is not JUST a Fatty Liver. Karen F. Murray, M.D. Director of Hepatobiliary Program Children s Hospital and Regional Medical Center NASH: It is not JUST a Fatty Liver Karen F. Murray, M.D. Director of Hepatobiliary Program Children s Hospital and Regional Medical Center Stages of Fatty Liver Disorders Fatty Liver 16-35% of Western

More information

1.How did I get Hepatitis C?

1.How did I get Hepatitis C? 1.How did I get Hepatitis C? Sharing needles and syringes ( iv drug use ) or using contaminated straws to snort cocaine Reused needles or medications in a health care setting- (LV endoscopy outbreak, glucometers

More information

Non-invasive evaluation of liver fibrosis: current clinical use and next perspectives (chronic hepatitis C)

Non-invasive evaluation of liver fibrosis: current clinical use and next perspectives (chronic hepatitis C) Non-invasive evaluation of liver fibrosis: current clinical use and next perspectives (chronic hepatitis C) Paul Calès Liver and Gastroenterology department, University hospital & HIFIH laboratory, Angers

More information

Hepatitis C. Eliot Godofsky, MD University Hepatitis Center Bradenton, FL

Hepatitis 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 information

Abnormal Liver Function. Dr William Alazawi MA(Cantab) PhD MRCP Senior Lecturer and Consultant in Hepatology Queen Mary, University of London

Abnormal Liver Function. Dr William Alazawi MA(Cantab) PhD MRCP Senior Lecturer and Consultant in Hepatology Queen Mary, University of London Abnormal Liver Function Dr William Alazawi MA(Cantab) PhD MRCP Senior Lecturer and Consultant in Hepatology Queen Mary, University of London Does Liver Disease Matter? Mortality in England & Wales Liver-related

More information

HEPATITIS C. The Facts. Get Tested. Get Cured! Health

HEPATITIS C. The Facts. Get Tested. Get Cured! Health HEPATITIS C The Facts Get Tested. Get Cured! Health EVEN IF YOU FEEL HEALTHY, HEPATITIS C MAY BE DAMAGING YOUR LIVER. Your liver keeps you healthy in many ways, such as by removing toxins from your blood

More information

LIVER CANCER AND TUMOURS

LIVER CANCER AND TUMOURS LIVER CANCER AND TUMOURS LIVER CANCER AND TUMOURS Healthy Liver Cirrhotic Liver Tumour What causes liver cancer? Many factors may play a role in the development of cancer. Because the liver filters blood

More information

June 11, 2015 Tim Halterman

June 11, 2015 Tim Halterman June 11, 2015 Tim Halterman Defini&on Histologic change + loss of liver function Derives from Greek word kirrhos meaning yellow, tawny First named by Rene Laennec in 1819 Laennec s cirrhosis=alcoholic

More information

Hepatocellular Carcinoma: What the hepatologist wants to know

Hepatocellular Carcinoma: What the hepatologist wants to know Hepatocellular Carcinoma: What the hepatologist wants to know Hélène Castel, MD Liver Unit Hôpital St-Luc CHUM? CAR Annual Scientific Meeting Saturday, April 27 th 2013 Disclosure statement I do not have

More information

Hepatitis C Virus Infection

Hepatitis C Virus Infection Focus on CME at the University of British Columbia Long-Term Management of Hepatitis C Virus Infection Hepatitis C virus is now the main cause of chronic liver disease in North America and, as such, family

More information

Objectives. Hepatitis C: The new era of screening and treatment. Distribution of HCV genotypes 11/1/2014. History of HCV diagnosis and screening

Objectives. Hepatitis C: The new era of screening and treatment. Distribution of HCV genotypes 11/1/2014. History of HCV diagnosis and screening Objectives Hepatitis C: The new era of screening and treatment David Crabb, M.D. Department of Medicine, Indiana University and Eskenazi Health Describe the natural history of HCV infection Be able to

More information

HEPATOLOGY CLERKSHIP

HEPATOLOGY CLERKSHIP College of Osteopathic Medicine HEPATOLOGY CLERKSHIP Office for Clinical Affairs 515-271-1629 FAX 515-271-1727 Elective Rotation General Description This elective rotation is a four (4) week introductory,

More information

Managing LFT s in General Practice

Managing LFT s in General Practice Managing LFT s in General Practice Sulleman Moreea FRCP(Edin Edin) ) FRCS(Glasg Glasg) Consultant Gastroenterologist/Hepatologist Bradford Hospitals Trust The normal liver Managing LFT s History and examination

More information

Things You Don t Want to Miss in Multiple Myeloma

Things You Don t Want to Miss in Multiple Myeloma Things You Don t Want to Miss in Multiple Myeloma Sreenivasa Chandana, MD, PhD Attending Hematologist and Medical Oncologist West Michigan Cancer Center Assistant Professor, Western Michigan University

More information

PHARMACY PRIOR AUTHORIZATION

PHARMACY PRIOR AUTHORIZATION PHARMACY PRIOR AUTHORIZATION Hepatitis C Clinical Guideline Harvoni (sofosbuvir/ledipasvir), Sovaldi (sofosbuvir), Viekira PAK (ombitsavir, paritapravir/ritonavir, dasubavir), and Olysio (simeprevir) Authorization

More information

The most serious symptoms of this stage are:

The most serious symptoms of this stage are: The Natural Progression of Hepatitis C The natural history of hepatitis C looks at the likely outcomes for people infected with the virus if there is no medical intervention. However, the process of trying

More information

William Atkinson, MD, MPH Hepatitis B Vaccine Issues June 16, 2016

William 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 information

Hepatitis C: Update on Testing and Treatment. Karla Thornton, MD, MPH. Karla Thornton:

Hepatitis C: Update on Testing and Treatment. Karla Thornton, MD, MPH. Karla Thornton: Hepatitis C: Update on Testing and Treatment Karla Thornton, MD, MPH Karla Thornton: Thank you all for inviting me. I m very excited to be here today. My name is Karla Thornton. I m a professor in the

More information

Medical Policy An independent licensee of the Blue Cross Blue Shield Association

Medical Policy An independent licensee of the Blue Cross Blue Shield Association Hepatitis C Second Generation Antivirals (2015) Page 1 of 14 Medical Policy An independent licensee of the Blue Cross Blue Shield Association Title: See also: Hepatitis C Second Generation Antivirals Through

More information

Update on hepatitis C: treatment and care and future directions

Update on hepatitis C: treatment and care and future directions Update on hepatitis C: treatment and care and future directions Professor Greg Dore Viral Hepatitis Clinical Research Program, National Centre in HIV Epidemiology and Clinical Research, University of New

More information

The child with abnormal liver function tests

The child with abnormal liver function tests The child with abnormal liver function tests Dr Jane Hartley Consultant Paediatric Hepatologist Birmingham Children s Hospital, UK 1 st Global Congress CIP, Paris 2011 Contents Over view of liver anatomy,

More information

Hepatitis C Class Review

Hepatitis C Class Review Hepatitis C Class Review Drug Use Research & Management Program Oregon State University, 500 Summer Street NE, E35, Salem, Oregon 97301-1079 Phone 503-945-5220 Fax 503-947-1119 Month/Year of Review: January

More information