Hepatology

1
Hepatology

• J. Eileen Hay, MB, FRCP
• Moderator

2
Hepatology Case

• 35 year old Asian man comes for routine checkup
• Known HBsAg for 10 years with no follow-up
• Healthy, active examination normal
• ALT 93 (x2 ULN), AST 80
• Bilirubin, INR, CBC, AFP normal
• HBsAg , HBeAg -, anti-HBe
• HBV DNA 15,000 IU/ml

3
Hepatology Questions

• What is the optimal management for this patient
  at this time?
• Is a liver biopsy necessary?
• When should HCC screening be instituted for this
  patient?
• Will I need and can I get a liver transplant?

4
Moderators Take-Home PointsJ. Eileen Hay

• In CAH B, age, ALT levels, HBeAg status and HBV
  DNA levels are important for management decisions
• HBeAg-negative chronic hepatitis B consider Rx
  when ALT levels are persistently elevated, HBV
  DNA gt20,000 IU/ml and/or necroinflammation or
  fibrosis on biopsy. If ALT normal, biopsy may aid
  decision to treat patients if HBV DNA
  2,000-20,000 IU/ml
• HBeAg-negative, treatment-naïve, compensated
  patient ETV, ADV, TDF or IFNa/pegIFNa

5
Moderators Take-Home PointsJ. Eileen Hay

• Treatment with nucleoside analogues in
  HBeAg-negative hepatitis is long-term or until
  HBsAg seroconversion ( 5 at 5 years).
• HCC screening guidelines screen after age 40 in
  Asian male with chronic hep B without cirrhosis.
  Earlier screening if additional risk factors.
• Efficacy of antiviral therapy prevents
  progression to cirrhosis and therefore need for
  OLT in many cases of CAH B. But, where needed
  (cirrhosis and/or HCC), outcome from OLT is
  excellent with ongoing post-transplant antiviral
  therapy.