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Expert Insight Into: Current Best Practices in Hepatitis B Treatment: Optimizing Response while Avoiding Resistance
Although the primary goal of treatment in patients with chronic hepatitis B virus infection is maximum reduction of viral load, it can be difficult to determine which antiviral regimen is most likely to achieve that goal in individual patients. Dr. Adrian M. Di Bisceglie discusses a review article by Robert G. Gish, MD, offering guidance on the choice of first-line therapies in patients with chronic HBV. —
Article Review
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Expert Insight Into: Clinical Outcomes of HBV Superinfection in Chronic Carriers of HCV
Dr. W. Ray Kim discusses the effect of hepatitis B virus superinfection in chronic carriers of hepatitis C virus (HCV) on the severity of disease and the clearance of HCV. Acute hepatitis B was more often severe in HCV carriers, but resulted in clearance of HCV in one quarter of the patients. —
Article Review
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Expert Insight Into: Liver Fibrosis: Consensus Recommendations of the Asian Pacific Association for the Study of the Liver (APASL)
In this review, Dr. W. Ray Kim summarizes the recent recommendations of the Asian Pacific Association for the Study of the Liver (APASL) for the assessment of liver fibrosis in patients with chronic liver disease. The consensus statements include how to properly perform liver biopsies as well as the appropriateness of less invasive alternatives to biopsy.
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Article Review
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Expert Insight Into: Renal Dysfunction in Asian American Patients with Chronic Hepatitis B Treated with an Oral Nucleotide Analogue
Past clinical studies of renal dysfunction associated with the anti-HBV agent adefovir dipivoxil (ADV) were conducted using serum creatinine levels, a less accurate measure that may have underestimated ADV-related renal impairment. Dr. Steven-Huy B. Han examines and discusses the findings of a recent study that used the more accurate estimated glomerular filtration rate to investigate the impact of ADV on renal function in Asian-American patients with chronic HBV. —
Article Review
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Expert Insight Into: Early Serum HBsAg Drop: A Strong Predictor of Sustained Virological Response to Interferon alfa in HBeAg-Negative Patients
Compared with long-term, frequently indefinite treatment with nucleoside analogs, therapy with pegylated interferon alfa-2a (PEG IFN α-2a) is for a finite and much shorter period. However, the high rate of relapse with PEG IFN α-2a in HBeAg-negative patients has contributed to its limited use. Dr. Naoky Tsai discusses a recent study that demonstrates the strong predictive value of early on-treatment serum HBsAg levels in distinguishing patients who will develop sustained virologic response with short-term PEG IFN α-2a from those who will not benefit and should receive an alternative therapy.
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Article Review
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Case Study: HBeAg-Negative Turkish Patient
Chronic hepatitis can arise from multiple etiologies, including hepatitis B, hepatitis C, hepatitis D, autoimmune process, and more. Join Dr. Steven-Huy B. Han as he follows the case of a recent immigrant from Turkey whose clinical presentation is at odds with the results of her initial laboratory tests. Dr. Han’s discussion highlights the importance of recognizing risk factors and utilizing laboratory testing to make the diagnosis. —
Tx Reporter e-Newsletter
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Expert Insight Into: Interferon vs Nucleoside Analog vs Combination Interferon/Nucleoside Analog in the Treatment of Chronic Hepatitis D Virus (HDV) Infection
Chronic HDV is associated with an increased risk of cirrhosis and hepatocellular cancer compared with chronic HBV or HCV. At present, the only available therapy is interferon alpha, and many patients who receive treatment either relapse or do not respond. In an effort to improve response in these patients, a trial was conducted investigating the use of lamivudine as monotherapy or in combination with interferon. Robert G. Gish, MD, discusses the results and their application in the treatment of patients with chronic HDV. —
Article Review
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Expert Insight Into: Long-Term Chronic HBV Therapy with Investigational Nucleoside Associated with Myopathy
In the first ever report of clevudine-associated myopathy, the paper summarized in this course describes the clinical and pathologic features of the affected patients. Dr. Steven-Huy B. Han reviews the paper’s findings and offers commentary on what these findings mean for clinical practice. This course is part of Advanced Certificate Program IV: Bridging Cultural Differences to Improve HBV Treatment in Asian and Other Diverse Communities. —
Article Review
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Expert Insight Into: Is There a Meaningful Serum HBV DNA Cutoff Level for Therapeutic Decisions in HBeAg-Negative Chronic HBV Infection?
The availability of sensitive HBV DNA tests has raised the question of what DNA cut-off level should be used to differentiate between inactive chronic HBV carriers, who require regular follow-up only, and patients with HBeAg-negative chronic hepatitis B, who need treatment. A recent study demonstrates that there may be no single HBV DNA criterion that can be used in making this distinction. Dr. Tsai discusses these results and the study investigators' recommendations for identifying patients who need therapeutic intervention. —
Article Review
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Case Study: Chinese-Born HBeAg-Positive Pregnant Patient
Dr. Steven-Huy B. Han follows the case of a Chinese-born woman in her third trimester of pregnancy who is positive for HBsAg and HBeAg. His discussion demonstrates the management of chronic hepatitis B infection with consideration of both mother and baby. —
Tx Reporter e-Newsletter
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Expert Insight Into: Tenofovir Disoproxil Fumarate Versus Adefovir Dipivoxil for Chronic Hepatitis B
Dr. Robert Gish reviews the data from two phase 3 studies comparing tenofovir, which was recently approved to treat chronic hepatitis B, with adefovir. These findings will help clinicians select a treatment that will maximize efficacy and safety while minimizing the risk of resistance over the long term. —
Article Review
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New HBV Screening Guidelines from the CDC: Emphasis on Immigrants from Endemic Areas and Others at Risk for HBV
In this compelling interview, Drs. Adrian Di Bisceglie and Naoky Tsai, and Dr. John Ward, Director of the Viral Hepatitis Program at the CDC, discuss the new and expanded guidelines on HBV screening. Discussion includes the reasoning behind expanding the screening recommendations, the rationale for screening to identify persons with chronic HBV infection, and strategies to overcome barriers to implementing the new screening recommendations. This podcast is part of Advanced Certificate Program IV: Bridging Cultural Differences to Improve HBV Treatment in Asian and Other Diverse Communities.
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Audio Interview
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Case Study: HBeAg-Positive Vietnamese Patient
Dr. Naoky C.S. Tsai follows a Vietnamese-born man found to be infected with HBV after his brother was diagnosed with HBV-related hepatocellular carcinoma. This case highlights the importance of assessing treatment candidacy, choosing a regimen, and monitoring adherence. —
Tx Reporter e-Newsletter
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Expert Insight Into: Systematic Review: The Effect of Preventive Lamivudine on Hepatitis B Reactivation During Chemotherapy
For patients with cancer who are also chronically infected with HBV, immunosuppressive chemotherapy can trigger a potentially fatal viral flare. Dr. Adrian Di Bisceglie reports on the findings of a meta-analysis that assessed whether prophylactic lamivudine could prevent viral reactivation during chemotherapy. —
Article Review
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