Podcasts about hbsag

In this episode, Patricia D. Jones, MD, MSCR; Mindie H. Nguyen, MD, MAS, AGAF, FAASLD; and patient advocate, Jennifer Wild, MS, RN, OCN, discuss practical strategies to overcome barriers to hepatitis B virus (HBV) care, including: Overcoming health insurance navigation Improving access to HBV care in immigrant communitiesDispelling HBV myths and stigmaSolutions to language barriersCommunity-based interventionsPresenters:Patricia D. Jones, MD, MSCRAssociate Professor of Clinical MedicineDirector of Clinical Operations-HepatologyDivision of Digestive Health and Liver DiseasesDepartment of MedicineUniversity of Miami Miller School of MedicineSylvester Comprehensive Cancer CenterMiami, FloridaMindie H. Nguyen, MD, MAS, AGAF, FAASLDProfessor of Medicine (GI & Hepatology,Liver Transplant)Professor of Epidemiology & Population Health(by Courtesy)Director of Hepatology ClerkshipFaculty Search LENS Advocates,Stanford Department of MedicineFaculty Fellow, Stanford Center for Innovationin Global HealthMember, Stanford Cancer Institute, Maternal &Child Health Research Institute, & Stanford Bio-CStanford, CaliforniaPast Chair: HBV SIG, The American Association for the Study of Liver Diseases (AASLD)28th President: The International Association for the Study of the Liver (IASL)Jennifer Wild, MS, RN, OCNClinical Nurse – GI Medical OncologyUCSF Cancer CenterSan Francsico, CaliforniaLink to full program: https://bit.ly/4j973TNDownloadable slides: https://bit.ly/3WQkIWlGet access to all of our new podcasts by subscribing to the CCO Infectious Disease Podcast on Apple Podcasts, Google Podcasts, or Spotify.

In this episode, Patricia D. Jones, MD, MSCR; Mindie H. Nguyen, MD, MAS, AGAF, FAASLD; and patient advocate, Jennifer Wild, MS, RN, OCN, discuss best practices in hepatitis B virus (HBV) care, including: 2023 CDC HBV screening recommendationsSummary of guideline recommendations for hepatitis delta virus (HDV) screening Use of HDV reflex testing to avoid loss to follow-up2024 WHO HBV treatment recommendations, including recommendations for pregnant persons Presenters:Patricia D. Jones, MD, MSCRAssociate Professor of Clinical MedicineDirector of Clinical Operations-HepatologyDivision of Digestive Health and Liver DiseasesDepartment of MedicineUniversity of Miami Miller School of MedicineSylvester Comprehensive Cancer CenterMiami, FloridaMindie H. Nguyen, MD, MAS, AGAF, FAASLDProfessor of Medicine (GI & Hepatology,Liver Transplant)Professor of Epidemiology & Population Health(by Courtesy)Director of Hepatology ClerkshipFaculty Search LENS Advocates,Stanford Department of MedicineFaculty Fellow, Stanford Center for Innovationin Global HealthMember, Stanford Cancer Institute, Maternal &Child Health Research Institute, & Stanford Bio-CStanford, CaliforniaPast Chair: HBV SIG, The American Association for the Study of Liver Diseases (AASLD)28th President: The International Association for the Study of the Liver (IASL)Jennifer Wild, MS, RN, OCNClinical Nurse – GI Medical OncologyUCSF Cancer CenterSan Francsico, CaliforniaLink to full program: https://bit.ly/4j973TNDownloadable slides: https://bit.ly/3WQkIWlGet access to all of our new podcasts by subscribing to the CCO Infectious Disease Podcast on Apple Podcasts, Google Podcasts, or Spotify.

In this episode, learn how early and sustained HBV care can be enhanced by expanding the role of primary care providers in HBV management. Learn how to:Engage key stakeholders in the provision of HBV care​Provide HBV management resources to support PCPs who are doing screening​Consider specialty and primary care collaborations that empower PCPs with clear guidance on how to manage patients living with HBVPresenters:Su Wang, MD, MPH, FACPMedical DirectorCenter for Asian Health and Viral Hepatitis ProgramsCooperman Barnabas Medical CenterRWJBarnabas-Rutgers Medical GroupAssociate MemberHealth Care Policy and Aging ResearchThe Rutgers Institute for HealthSenior AdvisorGlobal Health, Hepatitis B FoundationFlorham Park, New JerseyRichard R. Andrews, MD, MPHPresident, Houston Viral Hepatitis Task ForceFormer Co-Chair, National Task Force on Hepatitis BBoard-Certified Family MedicineAddiction Medicine PhysicianHouston, TexasRuth Brogden, MPHPatient AdvocateAmy S. Tang, MDFormer Co-Chair, National Task Force on Hepatitis BDirector of Immigrant HealthNorth East Medical ServicesSan Francisco, CaliforniaLink to full program: https://bit.ly/3TuqFHILink to the slides:https://bit.ly/44hXpHuGet access to all of our new podcasts by subscribing to the CCO Infectious Disease Podcast on Apple Podcasts, Google Podcasts, or Spotify.

In this episode, learn how early and sustained HBV care can be enhanced by expanding the role of primary care providers in HBV management. Learn how to:Engage key stakeholders in the provision of HBV care​Provide HBV management resources to support PCPs who are doing screening​Consider specialty and primary care collaborations that empower PCPs with clear guidance on how to manage patients living with HBVPresenters:Su Wang, MD, MPH, FACPMedical DirectorCenter for Asian Health and Viral Hepatitis ProgramsCooperman Barnabas Medical CenterRWJBarnabas-Rutgers Medical GroupAssociate MemberHealth Care Policy and Aging ResearchThe Rutgers Institute for HealthSenior AdvisorGlobal Health, Hepatitis B FoundationFlorham Park, New JerseyRichard R. Andrews, MD, MPHPresident, Houston Viral Hepatitis Task ForceFormer Co-Chair, National Task Force on Hepatitis BBoard-Certified Family MedicineAddiction Medicine PhysicianHouston, TexasRuth Brogden, MPHPatient AdvocateAmy S. Tang, MDFormer Co-Chair, National Task Force on Hepatitis BDirector of Immigrant HealthNorth East Medical ServicesSan Francisco, CaliforniaLink to full program: https://bit.ly/3TuqFHILink to the slides:https://bit.ly/44hXpHuGet access to all of our new podcasts by subscribing to the CCO Infectious Disease Podcast on Apple Podcasts, Google Podcasts, or Spotify.

In this episode, learn how early and sustained HBV care can be enhanced by expanding the role of primary care providers in HBV management. Learn how to:Engage key stakeholders in the provision of HBV care​Provide HBV management resources to support PCPs who are doing screening​Consider specialty and primary care collaborations that empower PCPs with clear guidance on how to manage patients living with HBVPresenters:Su Wang, MD, MPH, FACPMedical DirectorCenter for Asian Health and Viral Hepatitis ProgramsCooperman Barnabas Medical CenterRWJBarnabas-Rutgers Medical GroupAssociate MemberHealth Care Policy and Aging ResearchThe Rutgers Institute for HealthSenior AdvisorGlobal Health, Hepatitis B FoundationFlorham Park, New JerseyRichard R. Andrews, MD, MPHPresident, Houston Viral Hepatitis Task ForceFormer Co-Chair, National Task Force on Hepatitis BBoard-Certified Family MedicineAddiction Medicine PhysicianHouston, TexasRuth Brogden, MPHPatient AdvocateAmy S. Tang, MDFormer Co-Chair, National Task Force on Hepatitis BDirector of Immigrant HealthNorth East Medical ServicesSan Francisco, CaliforniaLink to full program: https://bit.ly/3TuqFHILink to the slides:https://bit.ly/44hXpHuGet access to all of our new podcasts by subscribing to the CCO Infectious Disease Podcast on Apple Podcasts, Google Podcasts, or Spotify.

In this episode, Nancy Reau, MD, discusses new data on hepatitis B virus presented at AASLD 2023, including:Current therapiesStudies 108 and 110: Factors Linked With Lack of Virologic Suppression After 8 Yr of TAF or TDFKaiser Permanente Northern California: HCC or Death With TDF vs ETV for Chronic Hepatitis BEarly vs Late Postpartum Cessation of TDF Initiated for Prevention of Vertical HBV TransmissionInvestigational functional cure strategiesB-Together: Sequential Bepirovirsen and PegIFN Added to NA Therapy for Chronic HBV InfectionMARCH Part B: VIR-3434 ± VIR-2218 ± PegIFN Added to NA Therapy for Chronic HBV InfectionREEF-IT: JNJ-3989 + NA ± JNJ-6379 With PegIFN Add-on Consolidation in Patients With HBeAg-Positive CHBHBV003: VTP-300 + Nivolumab Added to NA Therapy for Chronic HBV InfectionCVP-NASVAC: Nasally Administered Therapeutic Vaccine for Chronic HBV InfectionPresenter:Nancy Reau, MDProfessor of MedicineRichard B. Capps Chair of HepatologyChief, Section of HepatologyAssociate Director, Solid Organ TransplantationRush University Medical Center Chicago, IllinoisLink to full program: https://bit.ly/47XJlU4

In this episode, Nancy Reau, MD, discusses new data on hepatitis B virus presented at AASLD 2023, including:Current therapiesStudies 108 and 110: Factors Linked With Lack of Virologic Suppression After 8 Yr of TAF or TDFKaiser Permanente Northern California: HCC or Death With TDF vs ETV for Chronic Hepatitis BEarly vs Late Postpartum Cessation of TDF Initiated for Prevention of Vertical HBV TransmissionInvestigational functional cure strategiesB-Together: Sequential Bepirovirsen and PegIFN Added to NA Therapy for Chronic HBV InfectionMARCH Part B: VIR-3434 ± VIR-2218 ± PegIFN Added to NA Therapy for Chronic HBV InfectionREEF-IT: JNJ-3989 + NA ± JNJ-6379 With PegIFN Add-on Consolidation in Patients With HBeAg-Positive CHBHBV003: VTP-300 + Nivolumab Added to NA Therapy for Chronic HBV InfectionCVP-NASVAC: Nasally Administered Therapeutic Vaccine for Chronic HBV InfectionPresenter:Nancy Reau, MDProfessor of MedicineRichard B. Capps Chair of HepatologyChief, Section of HepatologyAssociate Director, Solid Organ TransplantationRush University Medical Center Chicago, IllinoisLink to full program: https://bit.ly/47XJlU4

Should quantitative HBsAg testing be used routinely in clinical practice for patients living with chronic hepatitis B?In this episode, Tatyana Kushner, MD, MSCE, discusses the role of quantitative hepatitis B surface antigen testing in people living with chronic hepatitis B, including:Determination of inactive carrier statusPrediction of liver fibrosis/cirrhosisPrediction of hepatocellular carcinoma developmentMonitoring response to treatment, including future HBV treatments in the development pipelinePrediction of HBsAg lossJoining her for the panel discussion are Ira M. Jacobson, MD, and Paul Y. Kwo, MD.Presenters:Ira M. Jacobson, MDProfessor of MedicineDirector of HepatologyNYU Langone HealthNew York, New YorkTatyana Kushner, MD, MSCEAssociate ProfessorDivision of Liver DiseasesIcahn School of Medicine at Mount SinaiNew York, New YorkPaul Y. Kwo, MDProfessor of Medicine Director of Hepatology Stanford University School of MedicinePalo Alto, CaliforniaLink to the full program: https://bit.ly/3R1PMi4Link to the slides: https://bit.ly/3N5Fpsm

A 28-year-old woman with a longstanding history of injection drug use presents with a 10-day history of malaise, nausea, and fatigue, and a two day “yellow eyes”.  Physical exam reveals scleral icterus and mild hepatomegaly with right upper quadrant tenderness. Considering the possibility of acute hepatitis B in the differential, the NP anticipates laboratory results will include. A. The presence of hepatitis B surface antibody (HBsAb)B. Thrombocytosis.  C. Leukocytosis.  D. The presence hepatitis B surface antigen (HBsAg).  ---YouTube: https://www.youtube.com/watch?v=OGIvOMwCQCU&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=37Visit fhea.com to learn more!

In 1990, the ACOG released the “Perinatal Hepatitis B Prevention Program“. OB healthcare workers have doing universal screening for Hepatitis B using HBsAg in each pregnancy, ever since. However, there is a new guidance being released in September 2023 from the ACOG. This new guidance aligns with the national Hep B screening and testing recommendations from the CDC released March 2023. Are you familiar with the “Hep B triple screen”? Is antiviral therapy recommended for Hep B in pregnancy? When should it be used? And is breast-feeding still allowed in mothers with Hep B viral infection? We will cover all of this- and more- in this episode.

In this episode, Joseph Ahn, MD, MS, MBA; Christina Delacruz Leyson, MD; and Alice Chan, a person who experienced pregnancy as a person living with chronic hepatitis B, discuss solutions for overcoming barriers to HBV care in people of childbearing potential and their infants, including:HBV screening and vaccination in pregnancyManagement of pregnant people who are HBsAg positiveInfant careBreastfeedingPresenters: Joseph Ahn, MD, MS, MBAProfessor of Medicine, Section ChiefDivision of Gastroenterology and HepatologyOregon Health & Science UniversityPortland, OregonChristina Delacruz Leyson, MDAssociate ProfessorMedical Director, Liver Transplant ProgramProgram Director, Hepatology FellowshipUniversity of KentuckyLexington, KentuckyAlice Chan, person living with chronic hepatitis BLink to downloadable slides:https://bit.ly/3rXLTC7Link to program: https://bit.ly/3L3Kz6l

In this episode, Stefan Zeuzem, MD, discusses new data on viral hepatitis presented at EASL 2023, including:Hepatitis B virusDurability of response with bepirovirsenHBsAg loss with siRNA VIR-2218 combined with either VIR-3434 (novel monoclonal antibody) or pegIFN-alfaHepatitis delta virus96-week follow-up of immediate vs delayed bulevirtideOff-treatment response for lonafarnib + ritonavir ± pegIFN-alfa Safety and efficacy outcomes with siRNA JNJ-3989 + nucleos(t)ide analogueHepatitis C virusCollaborative service at opiate substitution treatment clinic to improve linkage to care in IrelandNurse-led test-and-treat program to increase screening and diagnosis at female prisons in the United KingdomFIND-C study using machine learning to improve screening-to-diagnosis ratio using clinical factors and social determinants of healthPresenter:Stefan Zeuzem, MDProfessor of Medicine Chief, Department of Medicine JW Goethe University Hospital Frankfurt, GermanyLink to full program: https://bit.ly/3JQQj3J

In this episode, Tarik Asselah, MD, PhD, and Ira Jacobson, MD, provide expert insight on HDV screening, diagnosis, and management, including:Approach to screeningBarriers to screening (eg, test availability)Disease progression and complicationsDifferentiating between coinfection and superinfectionApproach to treatment (eg, whom to treat and when, treatment options, considerations for combination therapy)Management of patients with decompensated cirrhosisSurrogate markers to measure treatment successRole of correcting thrombocytopenia before initiating therapyFaculty:Tarik Asselah, MD, PhDProfessor of Medicine Department of HepatologyHôpital BeaujonUniversité de ParisClichy, FranceIra Jacobson, MDProfessor of MedicineNYU School of MedicineDirector of HepatologyDivision of Gastroenterology and HepatologyNYU Langone HealthNew York, New YorkLink to full program: https://bit.ly/3yp1Lxf 

In this episode, Nancy Reau, MD, and Heiner Wedemeyer, MD, provide expert insight on HDV management, including:Use of noninvasive imaging or biopsy for staging liver diseaseScreening for hepatocellular carcinomaHBV treatmentRole of comedications (eg, erythropoietin, eltrombopag)Approach to complex cases, such as patients with:Significant fibrosis and low HDV RNA levelsHepatitis delta antibody positivity, but HDV RNA negativityHIV coinfectionDecompensated or recently decompensated cirrhosisFaculty:Nancy Reau, MDProfessor of MedicineChief, Section of HepatologyAssociate Director, Solid Organ TransplantationRichard B. Capps Chair of HepatologyRush University Medical CenterChicago, IllinoisHeiner Wedemeyer, MDProfessor and ChairmanDepartment of Gastroenterology, Hepatology and Endocrinology Hannover Medical SchoolHannover, GermanyLink to full program: http://bit.ly/3yp1Lxf

In this episode, Tatyana Kushner, MD, MSCE, and Stefan Zeuzem, MD, address key considerations when screening, diagnosing, and treating patients with HDV, such as:Barriers to HDV screening, including limitations to AASLD guideline recommendationsUse of double reflex testing to improve HDV diagnosisConsiderations for repeat HDV testing in patients who are HBsAg positive who previously tested negative for HDVUpdated CDC recommendations for HBV screening for all adults using a triple panel test Staging advanced liver disease in patients with HDVIndications for HDV treatment, including patients with low ALT levels and advanced or progressive liver diseaseTreatment landscape for HDVPersonal experiences with use of pegylated interferon for HDV treatment, including considerations for use in patients with compensated cirrhosisUpdates on novel HDV therapies, including:Summary of efficacy data on bulevirtide from clinical trialsInterpretation of results from D-LIVR, a phase III trial assessing the safety and efficacy of lonafarnib Link to full program: bit.ly/3yp1Lxf

In this episode, Maria Buti, MD, and Richard H. Davis, PA-C, address key considerations when screening, diagnosing, and treating patients with hepatitis delta virus (HDV), such as:Barriers to screening HDV screening based on patient risk factors Universal screening for all patients with positive hepatitis B surface antigen (HBsAg)Reflex testing Availability of commercial testingMonitoring suggestions in HBsAg positive and HDV antibody positive patients with negative HDV RNALimitations to evaluating advanced fibrosis in patients with HDVData on novel HDV therapies (eg, bulevirtide and lonafarnib)Extending HDV therapy (eg, peginterferon) based on treatment responseStopping rules (eg, HDV RNA negativity, HBsAg loss) for discontinuing HDV therapyFaculty:Maria Buti, MDProfessor of MedicineHospital Universitario Vall d'HebronBarcelona, SpainRichard H. Davis, PA-CSenior PAGastroenterologyUniversity of FloridaUF HealthGainesville, FloridaLink to full program: http://bit.ly/3yp1Lxf

In this episode, Nancy Reau, MD, and Lydia Tang, MBChB, discuss how to increase linkage to care rates for persons with hepatitis D virus, including:Updates on currently low rates of linkage to careBarriers preventing patients with HBV/HDV coinfection from engaging in careInterventions to increase retention in care for patients with HDV Faculty: Nancy Reau, MDProfessor of MedicineChief, Section of Hepatology Associate Director, Solid Organ Transplantation Richard B. Capps Chair of HepatologyRush University Medical CenterChicago, IllinoisLydia Tang, MBChB Assistant ProfessorDepartment of Infectious DiseasesUniversity of Maryland School of MedicineInstitute of Human VirologyBaltimore, MarylandLink to full program: https://bit.ly/41oYawrFollow along with the slides at: https://bit.ly/3XW6m4g

In this episode, Coleman I. Smith, MD, and Lydia Tang, MBChB, discuss how to screen for hepatitis delta virus (HDV), including:Algorithm for evaluation of HDVDiagnosis of different stages of HDV infection Strategies to increase HDV testing rates Faculty:Coleman I. Smith, MDProfessor of MedicineHepatologistGeorgetown Transplant InstituteGeorgetown UniversityWashington, DCLydia Tang, MBChB Assistant ProfessorDepartment of Infectious DiseasesUniversity of Maryland School of MedicineInstitute of Human VirologyBaltimore, MarylandLink to full program:http://bit.ly/41oYawrFollow along with the slides at: http://bit.ly/3XW6m4g

HIV and Hepatitis B share similar routes of transmission. In United States, a large cohort study of patients with HIV showed that over 10 % of men who had sex with men, over 8% of those who injected drugs and over 5% of heterosexual individuals with risk factors tested positive for HBsAg or detectable HBV DNA. Because of the shared transmission routes, there is an increased risk of HIV and HBV co-infection. Despite the advancement of ART, that has a very efficient suppression rate of the HIV and HBV replication, morbidity and mortality rates are still higher in patients with HIV-HBV co-infection. In this episode, Dr. Steven Fine, an infectious disease specialist affiliated with the University of Rochester and Anthony Jordan Health Center, speaks about the management of Hepatitis B in patients with HIV. CEI Trainings: https://ceitraining.org/courses/  Prevention and Management of Hepatitis B Virus Infection in Adults With HIV: https://www.hivguidelines.org/hiv-care/hbv-hiv/#tab_0 Hepatitis B Virus/HIV Coinfection: https://clinicalinfo.hiv.gov/en/guidelines/hiv-clinical-guidelines-adult-and-adolescent-arv/hepatitis-b-virushiv-coinfection People Coinfected with HIV and Viral Hepatitis: https://www.cdc.gov/hepatitis/populations/hiv.htm Request a free training: https://www.surveymonkey.com/r/HCVDUH_Trainings Dr. Steven Mark Fine

Akut hepatit, hepatik parankimde inflamasyonu ve hepatosit hasarının sebep olduğu karaciğer enzim yüksekliğini tanımlayan, 6 aydan kısa süren geniş bir spektrumu tanımlar. Sebepleri enfeksiyöz ve non-enfeksiyöz olarak ikiye ayrılır; enfektif olmayan sebepler otoimmün, toksik ve biliyer hastalıklara sekonder gelişebilir. Acil servis yaklaşımı; semptomları ve nedenleri tanımak, fulminan hepatik yetmezliğe gidişi tanımak, özellikle ilaç ilişkili durumlarda geri döndürülebilir durumları tanımak ve tedaviyi başlatmaktan oluşur. Sırasıyla bunları ele alalım. ​1–4​ Etiyoloji Kaynak: ichastaliklaridergisi.org Öykü ve Fizik Muayene Hasta spektrumu, asemptomatik karaciğer enzim yüksekliğinden fulminan karaciğer yetmezliğine kadar değişir. Başvuru şikayetleri arasında yorgunluk/halsizlik, ateş, mide bulantısı, kusma, baş ağrısı, iştahsızlık, karın ağrısı bulunur. Akut hepatitin sonraki aşamalarında sarılık, akolik dışkı ve koyu renkli idrar meydana gelebilir. Öyküde enfeksiyöz etkenlere olası maruziyet durumunu, günde 4 gr üzerinde kronik ya da 10 gr üzerinde akut asetaminofen kullanımını, antibiyotik kullanımını, takviye ürün kullanımını, madde kullanımını ya da mantar/bitki yeme öyküsünü sorgulamak gerekir. Muayenede palpasyonda hepatomegali ve sağ üst kadran hassasiyeti bulunur. Kolestatik hepatitte skleralar ikteriktir. Karaciğer yetmezliğine ve pıhtılaşma faktörlerinin sentezinde azalmaya ikincil olarak hastalarda ekimoz, kanama görülebilir. İlerleyen evrelerde hepatik ensefalopati söz konusudur. Bu konuda ileri okuma için Dr. Altuğ Kanbakan tarafından kaleme alınan ‘Acilci Gözüyle Hepatik Ensefalopati' yazısına göz atabilirsiniz. Tanı Acil serviste kullandığımız karaciğer fonksiyon testleri aspartat aminotransferaz (AST), alanin aminotransferaz (ALT), alkalen fosfataz (ALP) ve bilirubin ve pıhtılaşma faktörleridir. Hepatoselüler hepatitte AST ve ALT, ALP ve bilirubine göre daha yüksektir. Kolestatik paternde ise tam tersi görülür.  Karaciğer hasarı için ALT, iskelet ve kalp kasında da bulunan AST'ye göre daha spesifiktir. AST>ALT ise alkolik hepatit akla gelir, bazen tiroid ve kas hastalıklarında da bu durum görülebilir. Hepatosellüler katabolik/metabolik aktivitenin göstergeleri de yükselen amonyak ve bilirubindir. Bilirubin yüksekliği açısından intrahepatik/ekstrahepatik obstrüksiyon ve safra atılımında bozulmadan şüpheleniliyorsa hepatobiliyer USG, abdominal BT veya MRCP ile ileri görüntüleme gerekir. K vitaminine bağlı pıhtılaşma faktörleri (II, VII, IX, X) karaciğerin sentez fonksiyonunun azalmasına bağlı olarak düşer. Bu hasta grubunda INR >1,5 iken akut karaciğer yetmezliği düşünülür ve kötü prognostik gösterge olarak kabul edilir. Albüminde düşme karaciğer hasarına özgü olmadığı için akut hepatit tanısında yeri sınırlıdır. Amerikan Gastroenteroloji Derneği (ACG) tarafından anormal karaciğer fonksiyon testleri olan hastaların değerlendirilmesi için yayınlanan kılavuzda ALT ve AST'nin yükselme derecesine bağlı olarak başlangıç testleri ve yaklaşım değişir:​5​ Serum transaminazlarında hafif yükselme (normalin üst sınırının 5 katının altında): tam kan sayımı, AST, ALT, ALP, bilirubin, albümin, PT/INR, HAV IgG, HAV IgM, HBsAg, HBcAg, Anti HBs, Anti HCV ve demir paneli (serum demiri, total demir bağlama kapasitesi, serum transferrin saturasyonu ve serum ferritin) ve batın ultrasonu ile görüntüleme. Serum transaminazlarında şiddetli yükselme (normalin üst sınırının 15 katının üstünde): EBV ve CMV araştırılması, seruloplazmin, otoimmün belirteçler, asetaminofen içeren ilaç paneli testi ve idrar toksikolojisi. Kılavuz ayrıca vasküler tıkanıklığı ekarte etmek için hepatik ven, portal ven ve hepatik arterin Doppler USG görüntülemesinin yapılmasını önerir. Acil servis laboratuvar değerlendirmesi akut veya kronik alımı ya da alım şüphesi olan hastalarda asetaminofen, salisilat ve antiepileptik ilaç düzeyleri ile sepsisten şüpheleniliyorsa laktatı da içermelidir.

In this episode, listen as Robert G. Gish, MD, discusses key information on comparing current HBV vaccine formulations, and learn the best immunization practices for routine vaccination, including in special situations.Presenter:Robert G. Gish, MDProfessor of MedicineLoma Linda UniversityLoma Linda, CaliforniaAdjunct Professor of MedicineNevada School of MedicineLas Vega, NevadaClinical ProfessorUniversity of Nevada Reno  School of MedicineReno, NevadaClinical ProfessorUniversity of California Skaggs School of Pharmacy and Pharmaceutical SciencesSan Diego, CaliforniaMedical DirectorHepatitis B FoundationWashington, DCReview the downloadable slidesets at:https://bit.ly/3LJPPLzLink to full program:https://bit.ly/3OZ50Ta

Hepatitis delta virus (HDV) is the most severe form of viral hepatitis, yet many patients go undiagnosed. Increasing HDV awareness is an important step to correct this and ensure that at-risk patients receive screening and then treatment and monitoring following a positive test. Hear Grace LH Wong, MD, and Ming-Lung Yu, MD, PhD, discuss a call to action to increase healthcare professional and patient awareness of HDV. Presenters: Grace LH Wong, MDProfessorDirector, Medical Data Analytics Centre (MDAC)Deputy Director, Center for Liver HealthAssistant Dean (Learning Experience), Faculty of MedicineThe Chinese University of Hong KongHonorary ConsultantDivision of Gastroenterology and HepatologyDepartment of Medicine and TherapeuticsPrince of Wales HospitalHong KongMing-Lung Yu, MD, PhDChair ProfessorHepatobiliary DivisionDepartment of Internal Medicine and Hepatitis CenterKaohsiung Medical UniversityVisiting StaffHepatobiliary DivisionDepartment of Internal MedicineKaohsiung Medical University HospitalKaohsiung City, TaiwanLink to full program: https://bit.ly/3tlxa0H

Hepatitis delta virus (HDV) is the most severe form of viral hepatitis and warrants new treatment options for better efficacy and tolerability. In part 2 of this 2-part podcast series, hear Heiner Wedemeyer, MD, and Cihan Yurdaydin, MD, discuss their thoughts on new and emerging treatment options for HDV and rational use of these new agents. Their discussion includes:Assembly inhibitors (eg, lonafarnib)Entry inhibitors (eg, bulevirtide)Interferon lambdaNucleic acid polymersSmall interfering RNA (siRNA) agentsPresenters: Heiner Wedemeyer, MDProfessor and ChairmanDepartment of Gastroenterology, Hepatology, and EndocrinologyHannover Medical SchoolHannover, GermanyCihan Yurdadin, MDProfessor and Chief Department of Gastroenterology and HepatologyKoç University Medical SchoolIstanbul, TurkeyLink to full program:https://bit.ly/365VUlG

In this episode, Jordan J. Feld, MD, MPH, and Nancy Reau, MD, share lessons learned in the testing and treatment of viral hepatitis in the COVID-19 era, including:Global impact of the COVID-19 pandemic on viral hepatitis testing and linkage to careImpact of COVID-19 pandemic on testing and treatment in the United States and CanadaInnovative strategies to improve linkage to care of patients with viral hepatitis during the COVID-19 pandemicPresenters:Jordan J. Feld, MD, MPHProfessor of MedicineUniversity of TorontoHepatologistToronto Centre for Liver DiseaseSandra Rotman Centre for Global HealthToronto, CanadaNancy Reau, MDProfessor of MedicineChief, Section of HepatologyAssociate Director, Solid Organ TransplantationRichard B. Capps Chair of HepatologyRush University Medical CenterChicago, IllinoisFollow along with the slides at:https://bit.ly/3HQ6dZ5Link to full program:https://bit.ly/3Bgyd5I

Hepatitis delta virus (HDV) only exists in patients with hepatitis B virus (HBV) coinfection. In part 1 of this 2-part podcast series, hear Heiner Wedemeyer, MD, and Cihan Yurdaydin, MD, discuss their thoughts on serologic testing for both HDV and HBV and steps to take in monitoring, treating, and reassessing HBV in patients coinfected with HDV.Presenters:Heiner Wedemeyer, MDProfessor and ChairmanDepartment of Gastroenterology, Hepatology, and EndocrinologyHannover Medical SchoolHannover, GermanyCihan Yurdaydin, MDProfessor and Chief, Department of Gastroenterology and HepatologyKoç University Medical SchoolIstanbul, TurkeyLink to full program:https://bit.ly/365VUlG

Treatment options for hepatitis delta virus (HDV) are lacking, but many exciting agents are under investigation. Hear Drs Nancy Reau and Stefan Zeuzem discuss their thoughts on up-and-coming agents for treating HDV, and explore what questions need answering to most effectively use currently available and emerging therapies, which include:BulevirtideInterferon λLonafarnibPresenters:Nancy Reau, MDProfessor of MedicineChief, Section of HepatologyAssociate Director, Solid Organ TransplantationRichard B. Capps Chair of HepatologyRush University Medical CenterChicago, IllinoisStefan Zeuzem, MDProfessor of MedicineChief, Department of Medicine IJW Goethe University HospitalFrankfurt, GermanyLink to full program:https://bit.ly/3tlxa0H

In this episode from the series “Key Decisions in HIV Care,” Daria Podlekareva, MD, PhD, and Mark S. Sulkowski, MD, discuss important considerations for ART use in patients with coinfections, including:DHHS testing and treatment recommendations for HBV in patients with HIVData suggesting that tenofovir alone may not suppress HBV in all PWHData from NA-ACCORD showing that incomplete HBV DNA suppression is associated with HCC in patients with HIV/HBVData for the use of entecavir as an add-on therapy if an HIV ART regimen is not HBV activeData showing that lamivudine alone is associated with resistance in patients with HIV/HBVDiscussion of HBV management in the setting of 2-drug regimens for HIV if the patient is coinfectedRecommendations from the DHHS, EACS, and WHO to start ART as soon as possible in patients with TB/HIV coinfectionData from the SAPiT, ACTG A5221 STRIDE, and CAMELIA studies to show the benefits of early ART in patients with TB/HIVRecommendations from the EACS guidelines on what ART regimens are recommended with TB/HIVDrug-drug interaction considerations between ART and TB treatmentDiscussion of the prevention and management of TB-associated IRISPresenters:Daria Podlekareva, MD, PhDCentre of Excellence for Health, Immunity and Infection (CHIP)Rigshospital, University of CopenhagenCopenhagen, Denmark  Mark S. Sulkowski, MDProfessor of MedicineMedical Director, Viral Hepatitis CenterChief, Infectious DiseaseJohns Hopkins Bayview Medical CenterJohns Hopkins University School of MedicineBaltimore, MarylandContent based on an online CME program supported by educational grants from Gilead Sciences, Inc.; Janssen Therapeutics, Division of Janssen Products, LP; and ViiV Healthcare.Follow along with slides:https://bit.ly/3zHySMOSee the entire program at:https://bit.ly/2TXTYWx

In this episode, Geoffrey Dusheiko, FRCP, FRCP (Edin), FCP (SA), and Ming-Lung Yu, MD, PhD, discuss key racial inequities of care that lead to undertreatment for migrant populations and other racial minorities globally with or at risk for hepatitis B. In addition, they discuss plans to improve engagement across the care continuum and strategies to combat implicit racial biases that affect optimal HBV care.Topics include:Differences in the burden of HBV globallySuboptimal engagement of HBV careStigma associated with HBV careKey strategies for overcoming racial barriersFirst-hand patient storiesGeoffrey Dusheiko, FRCP, FRCP (Edin), FCP (SA)Emeritus Professor of MedicineConsultant HepatologistUniversity College London Medical SchoolProfessorLiver UnitKings College HospitalLondon, United KingdomMing-Lung Yu, MD, PhDChair ProfessorHepatobiliary DivisionDepartment of Internal Medicine and Hepatitis CenterKaohsiung Medical UniversityVisiting StaffHepatobiliary DivisionDepartment of Internal MedicineKaohsiung Medical University HospitalKaohsiung City, TaiwanKaohsiung City, Taiwan Content based on a CME program supported by educational grants provided by AbbVie; Gilead Sciences, Inc.; and Janssen Therapeutics, Division of Janssen Products, LP To follow along, download the slides at:https://bit.ly/3gWStjZLink to full program: https://bit.ly/3kKIb9a

Good morning and welcome to your Friday dose of Your Daily Meds.Bonus Review: What are the major blood groups? How are they determined and why are they important?Answer: ‘Blood groups’ is a term that is used to refer to the genetically determined antigens that are present in the membranes of red blood cells. The importance of these ‘groups’ then, is related to the degree of antigenicity of these antigens in the membrane.The ABO grouping system are the most important because they are the most antigenic. The Rhesus (Rh) grouping system also has significant antigenicity.Then there are many other descriptors and systems of blood grouping which describe antigens of much lower clinical importance.Case:Which of the following patterns of serological test results indicates vaccination against hepatitis B virus infection?HBsAg negative; Anti-HBc positive; Anti-HBs positiveHBsAg negative; Anti-HBc negative; Anti-HBs negativeHBsAg negative; Anti-HBc negative; Anti-HBs positiveHBsAg positive; Anti-HBc positive; Anti-HBs negativeHBsAg positive; Anti-HBc negative; Anti-HBs positive(Where: HBsAg = hepatitis B surface antigen; Anti-HBc = antibodies to hepatitis B core antigen; Anti-HBs = antibodies to hepatitis B surface antigen)Pause for a moment.Sift through this pile of acronyms.And scroll for the chat.Ward Call:You have just arrived to start your evening shift when you receive a call from the maternity ward about a patient who is receiving a blood transfusion.Hi Doctor, could you please come and review Mrs Smith in the maternity ward? We started a blood transfusion for her approximately 15 minutes ago and now she is a bit unsettled. She is a little bit warm at 37.9 degrees and looks a bit flushed across her chest. I am worried she is having a transfusion reaction.While you have this nurse on the phone, what further questions could you ask to triage this concern?Have a think.More scroll for more chat.The Big B:The pattern of serological investigations in the patient vaccinated against hepatitis B virus infection is characterised by the patient testing negative for hepatitis B surface antigen (HBsAg), negative to antibodies to hepatitis B core antigen (anti-HBc) and positive for antibodies to hepatitis B surface antigen (anti-HBs). The patterns of serological test results for hepatitis B infection are given in the following table:Hot and Bothered:Alright. Some questions you could ask over the phone to triage your concern regarding a transfusion reaction include:What symptoms does the patient have?Fevers, chills, chest pain, back pain, diaphoresis and dyspnoea can all be manifestations of a transfusion reaction.What are the vital signs?Need to know as anaphylaxis will look very different to fever alone.Which blood product is being transfused?How long ago was it started?Instant anaphylaxis reaction versus effects of fluid overload etc.What was the reason for admission?Symptomatic anaemia post caesarean section versus ongoing haemorrhage etcMost transfusion reactions are non-haemolytic febrile reactions, especially if this is a multi-transfused or multiparous patient, and are due to WBC antigen-antibody reactions or cytokines. The transfusion does not need to be stopped and she may just need some paracetamol and promethazine.BUTThe reason you are asking some questions over the phone is because the major threats to life with transfusions include:Anaphylaxis = deadnessAcute Haemolytic Reaction - can cause Disseminated Intravascular Coagulation (DIC) = deadnessTransfusion-Related Acute Lung Injury (TRALI) - respiratory failure = deadnessTransfusion-Associated Circulatory Overload (TACO) - circulatory failure = deadnessBacterial contamination - septic shock = deadnessBonus: Consider a Rhesus (Rh) positive foetus being carried by a Rh negative mother in her first pregnancy. Would that foetus be affected by the mother’s antibodies against foetal red blood cells?Answer in Monday’s dose.Closing:Thank you for taking your Meds and we will see you Monday for your MANE dose. As always, please contact us with any questions, concerns, tips or suggestions. Have a great day!Luke.Remember, you are free to rip these questions and answers and use them for your own flashcards, study and question banks. Just credit us where credit is due. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit yourdailymeds.substack.com

“VAXELIS may be used to complete the hepatitis B vaccination series following 1 or 2 doses of other hepatitis B vaccines, in infants and children born of HBsAg-negative mothers and who are also scheduled to receive the other antigens in VAXELIS. However, data are not available on the safety and effectiveness of VAXELIS in such infants and children. Administration of VAXELIS following previous doses of Inactivated Polio Vaccine (IPV) VAXELIS may be administered to infants and children who have received 1 or 2 doses of IPV and are also scheduled to receive the other antigens in VAXELIS. However, data are not available on the safety and effectiveness of VAXELIS in such infants and children. Administration of VAXELIS following previous doses of Haemophilus b Conjugate Vaccines VAXELIS may be administered to infants and children who have received 1 or 2 doses of H. influenzae type b Conjugate Vaccine and are also scheduled to receive the other antigens in VAXELIS. However, “Each 0.5 mL dose contains 319 mcg (0.319 mg ) aluminum from aluminum salts used as adjuvants.Active ingredients: inactivated bacteria of diphtheria, tetanus, pertussis, Hib, and inactivated hepatitis B and polio viruses. The bacteria and viruses in VAXELIS are not alive and do not cause disease. • Other ingredients: aluminum salts, polysorbate 80, glutaraldehyde, formaldehyde, bovine serum albumin, neomycin, streptomycin, polymyxin B, ammonium thiocyanate, yeast protein, and waterwww.vaccinesafety.edu 

In this episode, we discuss updated guidelines on the screening and management of hepatitis B virus (HBV) in patients about to start anticancer therapy. The guidelines come from an American Society of Clinical Oncology Provisional Clinical Opinion (PCO) published earlier this year. Jessica P. Hwang, MD, of MD Anderson Cancer Center, and Andrew Artz, MD, of City of Hope, are cochairs of the ASCO PCO. They joined host David H. Henry, MD, to discuss the guidelines. Epidemiology of HBV Data suggest chronic HBV infection affects 257 million people globally. In the United States, chronic HBV infection has a prevalence of less than 1%, but the prevalence of past HBV can be 5%-40% in high-risk populations. High-risk populations include people born in endemic areas (i.e., Africa, Asia, and South America), those with injection drug use, men who have sex with men, and people with household contacts who have HBV. In patients with cancer, the prevalence of past HBV infection is 5%-10%, with a 0.5% prevalence of chronic HBV. HBV and oncology: Who should be screened? The ASCO PCO recommends universal HBV screening in all patients planning or undergoing anticancer therapy. To screen, practitioners should order three tests before initiating anticancer therapy: hepatitis B surface antigen (HBsAg), hepatitis B core antibody (anti-HBc) total immunoglobulin (Ig) or IgG, and hepatitis B surface antibody (anti-Hbs). Interpretation of serology Chronic infection: HBsAg (+), anti-HBc (+), anti-HBs (-). Resolved past infection: HbsAg (-), anti-HBc (+), anti-HBs (+). Past infection, isolated core: HbsAg (-), anti-HBc (+), anti-HBs (-). Vaccine-induced immunity: HbsAg (-), anti-HBc (-), anti-HBs (+). Recommended treatment and/or monitoring Once a patient is infected, the HBV incorporates into the host genome and can live latently, so the patient is at risk of reactivation with immunosuppressive anticancer therapy (with chronic or past infection). Certain therapies pose a heightened risk of HBV reactivation, including anti-CD20 monoclonal antibodies and stem cell transplant. Patients receiving checkpoint blockade immunotherapy should be monitored closely for reactivation, though autoimmune hepatitis and high-dose steroids used in treating immune-related events could confound the reactivation of HBV. Further guidelines specific to checkpoint blockade immunotherapy are dichotomized and can be found in the ASCO PCO. In patients with chronic HBV infection receiving any systemic anticancer therapy, the ASCO PCO recommends antiviral prophylactic therapy during anticancer therapy and for a minimum of 12 months after anticancer therapy, with consultation of an HBV specialist. Entecavir, tenofovir disoproxil fumarate, and tenofovir alafenamide are well tolerated and have a low rate of viral resistance, making them favorable for patients who need to be treated. Implementing a screening program Recommend a multidisciplinary team approach, including physicians, pharmacists, and public health professionals. Utilize EHRs to incorporate alerts for screening and embedding screening into order sets. Ensure that positive test results are delivered to the appropriate medical team. Link patients into care for treatment and/or monitoring. Source and resources The ASCO PCO was published in the Journal of Clinical Oncology: https://bit.ly/3pClNPo. Additional resources are available on the ASCO website: https://bit.ly/35E0nt0. An infographic is also available: https://bit.ly/3pBuE3K. Show notes written by Sheila DeYoung, DO, a resident at Pennsylvania Hospital, Philadelphia. Disclosures Dr. Hwang disclosed relationships with Gilead Sciences, Merck Sharp & Dohme, and the Asian Health Foundation. Dr. Artz disclosed research funding from Miltenyi Biotec. Dr. Henry has no relevant disclosures. *  *  * For more MDedge Podcasts, go to mdedge.com/podcasts Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgehemonc David Henry on Twitter: @davidhenrymd

FDA连续批准2个治疗胃肠道间质瘤的靶向药 Nature Review 肠易激综合征的中饮食疗法的循证医学证据和机制的见解Science子刊 生活方式和遗传因素使亚洲人易患胃癌阿伐普替尼（Avapritinib）胃肠道间质瘤（GIST）是胃肠道最常见的间叶细胞肿瘤，目前普遍认为是是由编码酪氨酸激酶受体蛋白基因（KIT）突变、或血小板源性生长因子受体 α（PDGFRα）基因激活突变所诱发。其中以KIT突变最常见，占80%；PDGFRα突变占10%，PDGFRα外显子18 D842V是最常见突变，与伊马替尼耐药相关；还有10%的患者缺少KIT或PDGFRα突变，称为野生型胃肠道间质瘤。阿伐普替尼（Avapritinib）是一种高效、选择性、口服生活性的KIT和PDGFRα抑制剂。2020年1月9日，FDA批准Avapritinib用于治疗经过基因检测确认的PDGFRα18外显子突变的不可切除（无法通过手术切除）或转移性（癌细胞扩散至身体其他部位）胃肠道间质瘤患者。《NAVIGATOR研究：阿伐普替尼治疗PDGFRα D842V基因突变的、晚期胃肠道间质瘤的研究》Lancet Oncology，2020年7月 (1)NAVIGATOR研究是一项两部分、开放标签、剂量递增和剂量扩大的1阶段研究。这篇文章对PDGFRA D842V突变的患者进行单独分析，并报道了研究结果。研究纳入无法手术切除的、胃肠道间质瘤患者，其中56人携带PDGFRα D842V突变，其中20位患者进入剂量递增组（即从30mg qd逐渐加量至最大耐受剂量），36位患者进入剂量扩大组（即使用最大耐受剂量）。最大耐受剂量为400mg qd，推荐剂量为300mg qd。中位随访15·9个月，在PDGFRα D842V突变的56名患者中，9%完全缓解，79%部分缓解。治疗相关严重不良反应最常见的是贫血。在30-400mg qd的剂量下，没有观察到药物毒性；600mg qd时，两名患者出现剂量相关的不良反应。结论：阿伐普替尼在晚期PDGFRα D842V突变的胃肠道间质肿瘤患者中具有初步的抗肿瘤活性。瑞普替尼（ripretinib） 瑞普替尼（ripretinib）是一种对广泛的KIT和PDGFRA基因突变激酶抑制剂。2020年5月，FDA批准瑞普替尼（ripretinib）用于晚期胃肠道间质瘤的四线治疗。《INVICTUS研究：瑞普替尼治疗晚期胃肠间质肿瘤的3期试验》Lancet Oncology，2020年7月 (2)这项双盲、随机、安慰剂对照的第三期研究中，纳入晚期、进展性胃肠间质肿瘤患者129人，既往均使用过伊马替尼、舒尼替尼和瑞格拉非尼在内的治疗。患者随机分入瑞普替尼 150mg qd或安慰剂组，随机分配到安慰剂组的患者在疾病进展时允许转到瑞普替尼组。双盲期，瑞普替尼组和安慰剂组的中位无进展生存期分别为6.3个月和1.0个月（风险比0.15，p < 0.0001）。最常见的严重不良反应包括脂肪酶升高、高血压、疲劳和低磷血症，两组发生率相似。结论：瑞普替尼显著提高晚期胃肠道间质瘤患者的无进展生存期。乙型肝炎急性和慢性乙型肝炎感染均刻有不同的临床表现。急性期，临床表现可从亚临床、或无黄疸型肝炎至黄疸型肝炎，有时还会出现爆发性肝炎（

FDA连续批准2个治疗胃肠道间质瘤的靶向药 Nature Review 肠易激综合征的中饮食疗法的循证医学证据和机制的见解Science子刊 生活方式和遗传因素使亚洲人易患胃癌阿伐普替尼（Avapritinib）胃肠道间质瘤（GIST）是胃肠道最常见的间叶细胞肿瘤，目前普遍认为是是由编码酪氨酸激酶受体蛋白基因（KIT）突变、或血小板源性生长因子受体 α（PDGFRα）基因激活突变所诱发。其中以KIT突变最常见，占80%；PDGFRα突变占10%，PDGFRα外显子18 D842V是最常见突变，与伊马替尼耐药相关；还有10%的患者缺少KIT或PDGFRα突变，称为野生型胃肠道间质瘤。阿伐普替尼（Avapritinib）是一种高效、选择性、口服生活性的KIT和PDGFRα抑制剂。2020年1月9日，FDA批准Avapritinib用于治疗经过基因检测确认的PDGFRα18外显子突变的不可切除（无法通过手术切除）或转移性（癌细胞扩散至身体其他部位）胃肠道间质瘤患者。《NAVIGATOR研究：阿伐普替尼治疗PDGFRα D842V基因突变的、晚期胃肠道间质瘤的研究》Lancet Oncology，2020年7月 (1)NAVIGATOR研究是一项两部分、开放标签、剂量递增和剂量扩大的1阶段研究。这篇文章对PDGFRA D842V突变的患者进行单独分析，并报道了研究结果。研究纳入无法手术切除的、胃肠道间质瘤患者，其中56人携带PDGFRα D842V突变，其中20位患者进入剂量递增组（即从30mg qd逐渐加量至最大耐受剂量），36位患者进入剂量扩大组（即使用最大耐受剂量）。最大耐受剂量为400mg qd，推荐剂量为300mg qd。中位随访15·9个月，在PDGFRα D842V突变的56名患者中，9%完全缓解，79%部分缓解。治疗相关严重不良反应最常见的是贫血。在30-400mg qd的剂量下，没有观察到药物毒性；600mg qd时，两名患者出现剂量相关的不良反应。结论：阿伐普替尼在晚期PDGFRα D842V突变的胃肠道间质肿瘤患者中具有初步的抗肿瘤活性。瑞普替尼（ripretinib） 瑞普替尼（ripretinib）是一种对广泛的KIT和PDGFRA基因突变激酶抑制剂。2020年5月，FDA批准瑞普替尼（ripretinib）用于晚期胃肠道间质瘤的四线治疗。《INVICTUS研究：瑞普替尼治疗晚期胃肠间质肿瘤的3期试验》Lancet Oncology，2020年7月 (2)这项双盲、随机、安慰剂对照的第三期研究中，纳入晚期、进展性胃肠间质肿瘤患者129人，既往均使用过伊马替尼、舒尼替尼和瑞格拉非尼在内的治疗。患者随机分入瑞普替尼 150mg qd或安慰剂组，随机分配到安慰剂组的患者在疾病进展时允许转到瑞普替尼组。双盲期，瑞普替尼组和安慰剂组的中位无进展生存期分别为6.3个月和1.0个月（风险比0.15，p < 0.0001）。最常见的严重不良反应包括脂肪酶升高、高血压、疲劳和低磷血症，两组发生率相似。结论：瑞普替尼显著提高晚期胃肠道间质瘤患者的无进展生存期。乙型肝炎急性和慢性乙型肝炎感染均刻有不同的临床表现。急性期，临床表现可从亚临床、或无黄疸型肝炎至黄疸型肝炎，有时还会出现爆发性肝炎（

An interview with Dr. Jessica Hwang from MD Anderson Cancer Center and Dr. Andrew Artz from City of Hope Cancer Center on “Hepatitis B Virus Screening and Management for Patients with Cancer Prior to Therapy: ASCO Provisional Clinical Opinion Update.” This update presents a clinically pragmatic approach to HBV screening and management that calls for universal HBV serological testing of patients at the onset of anticancer therapy. Read the full PCO at www.asco.org/supportive-care-guidelines Transcript The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement. Hello, and welcome to the ASCO Guidelines podcast series brought to you by the ASCO Podcast Network a collection of nine programs, covering a range of educational and scientific content and offering enriching insight into the world of cancer care. You can find all the shows including this one at podcast.asco.org. My name is Brittany Harvey. And today, I'm interviewing Dr. Jessica Hwang from the University of Texas M.D. Anderson Cancer Center in Houston, Texas, and Dr. Andrew Artz from the City of Hope Comprehensive Cancer Center in Duarte, California, co-chairs on hepatitis B screening and management for patients with cancer prior to therapy, ASCO provisional clinical opinion update. Thank you for being here, Dr. Hwang and Dr. Artz. Thank you for inviting us. Thank you so much. First, I'd like to note that ASCO takes great care in the development of its guideline products and ensuring that the ASCO conflict of interest policy is followed. The full conflict of interest information for this provisional clinical opinion panel is available online with the publication in the Journal of Clinical Oncology. Dr. Hwang, do you have any relevant disclosures that are related to this topic? Well, I have received some research funding from Gilead, a maker of a hepatitis drug in the past. And, Dr. Artz, do you have any relevant disclosures? I have no relevant disclosures. OK, then so, Dr. Artz, so this provisional clinical opinion, or PCO, on hepatitis B screening and management for patients with cancer prior to therapy was first published in 2010 and then last updated in 2015. What prompted this update to the PCO? This PCO guidance, more broadly, is necessary because the hepatitis B status for most patients is actually unknown at the time they're starting cancer therapy. In 2015, the PCO though suggested that we limit hepatitis B screening to patients who were at most risk for hepatitis B reactivation, if they were hepatitis B carriers, so those receiving anti-CD20 antibodies, such as rituximab or stem cell transplant. But for the remaining patients, most patients receiving cancer therapy, the guidance was to survey patients about their close contacts or exposures to hepatitis B and determine if formal hepatitis testing should ensue. This 2020 PCO represents an evolution in our understanding of hepatitis B screening and the dangers of hepatitis B after anticancer therapy. We've learned from studies, including those done by my colleague, Dr. Hwang, that questionnaires to detect hepatitis B are not very effective or practical. We also have accumulating information that many of our anticancer therapies pose a significant danger for hepatitis B related complications in hepatitis B infected patients. We believe appropriate monitoring and treatment, as outlined in the PCO, will reduce these dangers. So given that new information, I'd like to discuss the updated statements for the PCO. So first, Dr. Hwang, for patients who will receive systemic anticancer therapy, who should be tested for HBV and how should they be tested? That's a great question, Brittany. Thanks. I think that the data is really clear now that all patients with cancer anticipating systemic anticancer therapy should be tested for hepatitis B virus. That includes all solid tumor patients, as well as hematologic malignancy patients. And they can be tested with a simple blood test. The hepatitis B virus can be tested by three blood tests for hepatitis. It's the hepatitis B surface antigen, HBsAG, or the hepatitis B core antibody. There are two types of this. It's either the IgG or the total IG, which shows, if positive, could indicate a patient has past infection. There is a IgM version of that core antibody test. And that tells, if positive, tells whether a patient has acute infection. So for our purposes, it's recommended that the IgG or total IG is used and not the IgM, because we are interested in whether a patient has past infection. So the third test is a hepatitis B surface antibody. And this is a protective antibody. So if positive, it shows that a patient has had some exposure in the past or perhaps a vaccination in the past. And so this is a good test to have positive. So then what does the PCO state for patients with chronic HBV infection? Patients with chronic HBV infection, that is those patients with a positive hepatitis B surface antigen test, these patients really should have very close monitoring during as well as after anticancer therapy. These patients will need antiviral therapy prophylactically prior to enduring as well as after the cancer treatment. They should also see a clinician experienced in the management of hepatitis B, whether it's a hepatologist, a gastroenterologist, an infectious disease specialist, or maybe a primary care doctor who's experienced in treating and caring and monitoring for patients with hepatitis B. That's really important for these patients with a chronic hepatitis B, because they are at high risk of developing complications during and as well as perhaps even shortly thereafter of receiving systemic anticancer therapy. And then what does the PCO state for patients with past HBV infection? This is a really good question. The patients with past HBV infection are those who have a negative hepatitis B surface antigen and a positive hepatitis B core antibody. This represents maybe some 6% at least of the US population. It could be much higher. So this is a sizable group of patients. And it's really important to know that it is sort of a tailored approach. So patients with past HBV infection who are anticipated to receive one of the high risk anticancer therapies that Dr. Artz mentioned just a few moments ago, namely stem cell transplantation or maybe one of the anti-CD20 monoclonal antibodies, these patients are at really high risk of reactivation. So these patients would need a very close monitoring plan. They would need their hepatitis B and liver test monitored during their anticancer therapy. And most often they would need antiviral prophylaxis before, during, and even after their immunosuppressive therapy ends. So there are patients, of course, who don't receive these high-risk therapies. So that is patients with past HBV infection who are receiving anticancer therapy that's not a stem cell transplant and not an anti-CD20 monoclonal antibody. These patients could be monitored carefully. They could have hepatitis B and/or liver testing monitoring during anticancer therapy. And if they have any elevations in their surface antigen or their ALT, then they could have further hepatitis B testing to see if they have any evidence of complications from their hepatitis B. So that's in general what the PCO recommends for these two groups. Well, thank you for reviewing those highlights from the PCO. So Dr. Artz, what is the importance of this PCO and how will its implementation impact practice? Thank you for the question. This PCO I feel dramatically simplifies the challenge of hepatitis B screening by proposing universal hepatitis B testing, as Dr. Hwang outlined, at a defined point in time. That is at the initiation of therapy. And clinicians have really struggled with hepatitis B testing for lots of different reasons. They're difficulties in knowing who to screen, how to screen, in part because the data have started to emerge that many of the therapies may pose some risks and the prior suggestion that we use questionnaires, but there wasn't a standard set of questionnaires that we could use if we wanted to identify people based on risk factors of acquiring hepatitis B. So this led to a lot of confusion on testing. I think by standardizing this makes it considerably easier. And also, the guidance from the PCO is better harmonized with other organizations, such as the Centers for Disease Control and our Liver Society colleagues who actually participated in the panel. And so now the guidance clinicians receive are more consistent across organizations. So I think this will allow doctors and health care systems overall to now invest in the implementation of hepatitis B screening, rather than the question about who should we do it and can we do it and when should we do it, but rather more on the implementation to help patients. Great. And then finally, what is the impact of this updated PCO for patients? Well, I'll take the first part of that. I believe that the implementation should permit safer systemic anticancer therapy by reducing hepatitis B related complications. Whenever patients have complications or there's even uncertainty about whether hepatitis might be contributing, this also can lead to delays in our treatments. If we know in advance and we appropriately manage and monitor this, we should have fewer treatment delays as well. Dr. Hwang, I know, might also have some comments on this. Thanks. I do have a few general comments beyond the cancer care implications. And I'd like to say I think that hepatitis B testing and then the results of that and sharing that information with patients is really important. Letting patients know their hepatitis B status, especially if they're positive, empowers them to seek further care, get connected with a hepatitis B specialist person who's experienced in managing hepatitis B, and also to look around the local environment to their household and close contacts because hepatitis B is a virus that is transmitted from person to person through blood-borne sexual transmission and close family or household contact. So I think it's important for patients to know their status to protect themselves during cancer therapy, as Dr. Artz mentioned, but just in general for good health care for themselves and for those around them. And in addition, I think that it's important for the family members and those close contacts to then get screened and perhaps even consider getting vaccinated if they haven't been vaccinated. Well, thank you both for your hard work on updating this PTO and for taking the time to speak with me today, Dr. Hwang and Dr. Artz. Thank you, Brittany. Thank you, Brittany. And thank you to all of our listeners for tuning into the ASCO Guidelines podcast series. To read the full provisional clinical opinion go to www.asco.org/supportive-care-guidelines. This PCO also has a companion cancer.net podcast episode. Cancer.net is the patient information website of ASCO. And we encourage you to learn more by tuning into their episode. You can find their podcast and all ASCO podcasts at podcast.asco.org. You can also find many of our guidelines, PCOs, and interactive resources in the free ASCO Guidelines app, available on iTunes or the Google Play store. If you have enjoyed what you've heard today, please rate and review the podcast, and be sure to subscribe so you never miss an episode.

Integrating host and HBV characteristics, this study aimed to develop models for predicting long-term cirrhosis and hepatocellular carcinoma (HCC) risk in chronic hepatitis B virus (HBV) patients. This analysis included hepatitis B surface antigen (HBsAg)-seropositive and anti-HCV-seronegative participants from the Risk Evaluation of Viral Load Elevation and Associated Liver Disease/Cancer in HBV (R.E.V.E.A.L.-HBV) cohort. Newly developed cirrhosis and HCC were ascertained through regular follow-up ultrasonography, computerized linkage with national health databases, and medical chart reviews. Two-thirds of the participants were allocated for risk model derivation and another one-third for model validation. The risk prediction model included age, gender, HBV e antigen (HBeAg) serostatus, serum levels of HBV DNA, and alanine aminotransferase (ALT), quantitative serum HBsAg levels, and HBV genotypes. Additionally, the family history was included in the prediction model for HCC. Cox's proportional hazards regression coefficients for cirrhosis and HCC predictors were converted into risk scores. The areas under receiver operating curve (AUROCs) were used to evaluate the performance of risk models. Elder age, male, HBeAg, genotype C, and increasing levels of ALT, HBV DNA, and HBsAg were all significantly associated with an increased risk of cirrhosis and HCC. The risk scores estimated from the derivation set could accurately categorize participants with low, medium, and high cirrhosis and HCC risk in the validation set (P 

Dr. Guo-Rong Han discusses her manuscript, "Telbivudine Prevents Vertical Transmission from HBeAg-Positive Women with Chronic Hepatitis B."

Dr. Guo-Rong Han discusses her manuscript, "Telbivudine Prevents Vertical Transmission from HBeAg-Positive Women with Chronic Hepatitis B."

Die vorliegende Arbeit beschäftigt sich mit neuen Ansätzen zur Immuntherapie von B-Zell-Lymphomen. Als Mausmodell wurden das Lymphom A20 und der eher leukämisch wachsende BCL1-Tumor verwendet. Alle Zellen eines B-Zell-Lymphoms produzieren einen identischen Antikörper, den sogenannten Idiotyp, der als tumorspezifisches Antigen benutzt werden kann: Die antigenbindenden variablen Regionen von schwerer und leichter Kette sind für die Tumorzellen jedes Patienten spezifisch. Die variablen Regionen lassen sich mit einem flexiblen Linker-Peptid zu single-chain Fragmenten (scFv) fusionieren. Die Antigenbindung und die Struktur als Tumorantigen bleiben dabei erhalten. Die BCL1-Sequenz war bereits bekannt, sie ließ sich mit Hilfe familienspezischer Primer mit PCR amplifizieren und klonieren. Bei der stark hypermutierten Sequenz des A20-Idiotyps versagte das Standardverfahren der Konsensus-Primer, erst eine 5'-RACE-PCR war erfolgreich. Der optimale Effektormechanismus (humoral, CD4 oder CD8 vermittelt) zur Immuntherapie von Lymphomen ist nicht bekannt. Bei DNA-Vakzinen lässt sich die Immunantwort besonders effektiv modulieren. Hier wurde ein System entwickelt, um rasch die Wirksamkeit verschiedener Kombinationen in vivo untersuchen zu können: Der scFv-Idiotyp wurde mit einem Zytokin (IL1beta, IL4, IL12, GM-CSF oder Flt3 ligand) und/oder einem Adjuvans (Tetanus Toxin Fragment C oder HBsAg) gekoppelt. In vitro wurde die Expression, die Faltung des scFv und die biologische Aktivität bestätigt. Neben der spezifischen Zytokinwirkung stabilisieren die Fusionspartner die scFv-Proteine deutlich. Zunächst wurde mit dem Modellantigen HBsAg die Immunisierungstechnik optimiert: Intradermale Plasmid-Injektion in die Ohr Pinna ergab konsistent hohe Antikörper-Titer. Bereits ohne in vitro-Restimulation konnte eine starke zelluläre Antwort nachgewiesen werden. Weiterhin wurde für die beiden Tumormodelle A20 und BCL1 die Wachstumskinetik invivo bestimmt und ein Pilotversuch (32 Tiere) mit drei ausgewählten Konstrukten durchgeführt: Von sechs splenektomierten Mäusen zeigte nur eine nach zwei Immunisierungen eine spezifische zelluläre Antwort gegen A20. In keiner Versuchsgruppe zeigte sich eine signifikante Lebensverlängerung nach Lymphomchallenge. Zusammenfassend ist erstmalig ein System entwickelt worden, das es auf einfache Weise ermöglicht, die Wirksamkeit von verschiedenen Zytokinen und Adjuvantien zur Idiotyp-Vakzinierung zu untersuchen. Dieses System bietet viel Raum für Optimierungen.