Addressing Misunderstandings in Applying HBV Treatment Guidelines

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In this series of concise MedicalMinute presentations and accompanying downloadable slides, expert faculty interpet key guideline recommendations to address common misunderstandings in the management of patients with HBV infection.
Joseph Ahn, MD, MS, MBA
Maria Buti, MD
Anna Christina L. dela Cruz, MD
Geoffrey Dusheiko, FRCP, FRCP (Edin), FCP (SA)
Jordan J. Feld, MD, MPH
Robert G. Gish, MD
Ira M. Jacobson, MD
Paul Y. Kwo, MD
George Lau, MBBS (HKU), MD (HKU), FRCP (Edin, Lond), FAASLD (USA)
Francesco Negro, MD
Mindie H. Nguyen, MD, MAS, AGAF, FAASLD
Grace LH Wong, MD

AASLD Guidelines

Determining the level of fibrosis is key in evaluating patients for HBV treatment candidacy. How, when, and why should we incorporate fibrosis assessments into clinical practice? Here’s my take.

Paul Y. Kwo, MD Released: February 18, 2021

How I incorporate family history into HBV treatment and monitoring decisions in certain clinical gray zones.

Anna Christina L. dela Cruz, MD Released: April 15, 2021

Why I consider treatment for patients with immune-tolerant chronic HBV, and where I differ from current international guidance.

Ira M. Jacobson, MD Released: May 14, 2021

When managing pregnant patients with chronic HBV, the optimal timing for prophylaxis discontinuation postpartum remains unclear. Here’s my approach.

Joseph Ahn, MD, MS, MBA Released: July 13, 2021

This concise MedicalMinute presentation reviews the natural history of HBV infection and interpreting serology, HBV DNA, and fibrosis assessments to determine treatment candidacy.

Paul Y. Kwo, MD Physicians: maximum of 0.25 AMA PRA Category 1 Credits Registered Nurses: 0.25 Nursing contact hours Pharmacists: 0.25 contact hours (0.025 CEUs) Released: February 16, 2021 Expired: February 15, 2022

This concise MedicalMinute presentation reviews the AASLD guidelines on monitoring and treatment for patients with HBV infection, including a brief discussion of HCC risk in various patient populations.

Mindie H. Nguyen, MD, MAS, AGAF, FAASLD Physicians: maximum of 0.25 AMA PRA Category 1 Credits Registered Nurses: 0.25 Nursing contact hours Pharmacists: 0.25 contact hours (0.025 CEUs) Released: March 26, 2021 Expired: March 25, 2022

This concise MedicalMinute presentation reviews the AASLD recommendations on methods to assess liver fibrosis and inflammation and data and guidance on translating test results into management decisions.

Anna Christina L. dela Cruz, MD Physicians: maximum of 0.25 AMA PRA Category 1 Credits Registered Nurses: 0.25 Nursing contact hours Pharmacists: 0.25 contact hours (0.025 CEUs) Released: April 20, 2021 Expired: April 19, 2022

This concise MedicalMinute presentation reviews the AASLD recommendations for caring for pregnant women with chronic HBV infection, including considerations for monitoring, treatment indications, treatment options, and prophylaxis to prevent mother-to-child transmission.

Joseph Ahn, MD, MS, MBA Physicians: maximum of 0.25 AMA PRA Category 1 Credits Registered Nurses: 0.25 Nursing contact hours Pharmacists: 0.25 contact hours (0.025 CEUs) Released: July 8, 2021 Expired: July 7, 2022

In episode 2 of this ongoing series, listen to a conversation between Robert G. Gish, MD, FAASLD, and patient and advocate, Alan Wang, on approaches to destigmatize HBV infection and remove barriers to care.

Robert G. Gish, MD Released: April 12, 2021

In episode 3 of this ongoing series, listen to a conversation between Jordan J. Feld, MD, MPH, and Wendy, who is living with chronic hepatitis B, on incorporating shared decision-making to determine when to initiate treatment.

Jordan J. Feld, MD, MPH Released: May 11, 2021

In episode 5 of an ongoing series of sharing sessions between a physician and patient, Anna Christina L. dela Cruz, MD, and Rhonda, who is living with chronic hepatitis B, discuss what to do when the decision to start treatment is not clear because of borderline ALT test results and HBV DNA levels.

Anna Christina L. dela Cruz, MD Released: July 28, 2021

Review AASLD guideline recommendations informing HBV pretreatment evaluation, including serology, HBV DNA, and fibrosis assessments to determine treatment candidacy.

Paul Y. Kwo, MD Released: February 16, 2021

Review key data and AASLD guideline recommendations on HCC risk, considerations for treatment, and optimal HCC monitoring.

Mindie H. Nguyen, MD, MAS, AGAF, FAASLD Released: March 26, 2021

Review key data and AASLD guideline recommendations on methods to evaluate liver fibrosis and inflammation to guide management decisions for patients with HBV infection.

Anna Christina L. dela Cruz, MD Released: April 20, 2021

Review key data and AASLD guideline recommendations on managing HBV infection during pregnancy, including treatment indications, treatment options, and prophylaxis to prevent mother-to-child transmission.

Joseph Ahn, MD, MS, MBA Released: July 8, 2021

APASL Guidelines

Assessment of liver disease severity is often overlooked in the management of patients with HBV infection, but it can tip the scales when weighing the decision to treat or monitor.

Grace LH Wong, MD Released: March 17, 2021

Rapid expansion of the use of new immunosuppressive agents and failure to screen patients for HBV prior to therapy initiation can lead to HBV reactivation. Here’s my approach to preventing reactivation.

George Lau, MBBS (HKU), MD (HKU), FRCP (Edin, Lond), FAASLD (USA) Released: August 23, 2021

This concise MedicalMinute presentation reviews the APASL guidelines on treatment indications for patients with HBV infection, including a brief discussion of methods to assess fibrosis.

Grace LH Wong, MD Physicians: maximum of 0.25 AMA PRA Category 1 Credits Registered Nurses: 0.25 Nursing contact hours Pharmacists: 0.25 contact hours (0.025 CEUs) Released: March 5, 2021 Expired: March 4, 2022

Listen to expert insights on the limitations of the current APASL recommendations for screening and surveilling patients with chronic hepatitis B for hepatocellular carcinoma.

George Lau, MBBS (HKU), MD (HKU), FRCP (Edin, Lond), FAASLD (USA) Physicians: maximum of 0.25 AMA PRA Category 1 Credits Registered Nurses: 0.25 Nursing contact hours Pharmacists: 0.25 contact hours (0.025 CEUs) Released: October 7, 2021 Expired: October 6, 2022

In episode 1 of this ongoing series, listen to a conversation between Grace LH Wong, MD, and her patient, Ms. Chan, on the shared decision for Ms. Chan to start treatment for hepatitis B infection during her pregnancy.

Grace LH Wong, MD Released: March 26, 2021

Review APASL guideline recommendations informing HBV treatment candidacy, including fibrosis assessments and ongoing monitoring.

Grace LH Wong, MD Released: March 5, 2021

EASL Guidelines

Here’s why it’s important to look for HDV coinfection in patients with HBV.

Francesco Negro, MD Released: July 7, 2021

The role of host factors in the monitoring and treatment of chronic hepatitis B is an area largely unexplored by the guidelines. Here’s my approach to assessing patients for treatment candidacy in the setting of other host factors.

Maria Buti, MD Released: August 26, 2021

This concise MedicalMinute presentation reviews the EASL recommendations for the individualizing treatment of HBV infection in persons at risk of renal or bone disease and pregnant women.

Francesco Negro, MD Physicians: maximum of 0.25 AMA PRA Category 1 Credits Registered Nurses: 0.25 Nursing contact hours Pharmacists: 0.25 contact hours (0.025 CEUs) Released: May 11, 2021 Expired: May 10, 2022

Hear expert insights on when to treat HBV: which factors to consider and how often to monitor them.

Maria Buti, MD Physicians: maximum of 0.25 AMA PRA Category 1 Credits Registered Nurses: 0.25 Nursing contact hours Pharmacists: 0.25 contact hours (0.025 CEUs) Released: September 7, 2021 Expired: September 6, 2022

In episode 4 of this ongoing series, listen to a conversation between Geoffrey M. Dusheiko, MD, FCP(SA), FRCP, and his patient Mark, who presented with hepatitis B after receiving immunomodulatory treatment for rheumatoid arthritis.

Geoffrey Dusheiko, FRCP, FRCP (Edin), FCP (SA) Released: July 26, 2021

Review key data and EASL guideline recommendations on individualizing treatment for patients with HBV, including patients with renal or bone disease and pregnant women.

Francesco Negro, MD Released: May 11, 2021

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