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HEPATITIS B AN UPDATE ON TREATMENT

www.drsarma.in. HEPATITIS B AN UPDATE ON TREATMENT. Dr. R V S N Sarma MD MSc (Canada) FIMSA Consultant Physician and Cardio Metabolic Specialist. Who should be treated ?. When to treat in HBV course ? What is the treatment ?. Goal of Antiviral Therapy.

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HEPATITIS B AN UPDATE ON TREATMENT

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  1. www.drsarma.in HEPATITIS B AN UPDATE ON TREATMENT Dr. R V S N Sarma MD MSc (Canada) FIMSA Consultant Physician and Cardio Metabolic Specialist

  2. Who should be treated ? When to treat in HBV course ? What is the treatment ?

  3. Goal of Antiviral Therapy 1. Sustained suppression of HBV replication Decrease in serum HBV DNA to <105 copies/ml Seroconversion HBeAg to anti-HBe; HBsAg to anti-HBs 2. Remission of liver disease; Normalization of serum ALT levels Decreased necro-inflammation in liver • Improvement in clinical outcome; Decreased risks of developing cirrhosis, liver failure and HCC; • Increased survival

  4. For whom therapy is indicated Patients who have • Acute liver failure due to HBV • ALT of >2 x UNL and or HBV DNA > 20,000 IU/ml • Cirrhosis and clinical complications • Cirrhosis or advanced fibrosis & HBV DNA in serum • Reactivation of Chronic HBV after chemotherapy or immuno-suppression • Infants born to women who are HBsAg-positive • The immune-active phase who do not have advanced fibrosis or cirrhosis

  5. For whom therapy isnot indicated Patients with • Chronic hepatitis B in the immune-tolerant phase (with high levels of serum HBV DNA but normal serum ALT levels or little activity on liver biopsy) • Patients in the inactive carrier or low replicative phase (with low levels of or no detectable HBV DNA in serum and normal serum ALT levels) • Patients who have latent HBV infection (HBV DNA without HBsAg)

  6. Predictors of Response to Antivirals • High baseline ALT level • Low Baseline HBV DNA level • Mild-to-moderate histological activity • Mild to Moderate stage Liver Dysfunction • Genotype of the HBV – (A>B>C>D) • Baseline HBeAg positivity (wild virus) • Genetic barrier to resistance - Lamivudine, Telbivudine and to a lesser degree, Adefovir

  7. Predictors of HCC, Cirrhosis after CHBV • Persistently elevated HBV DNA • Persistently elevated ALT (SGPT) • HBV genotype C infection • Male Gender, Older age • Family history of HCC • Co-infection with HCV or HIV or HDV

  8. Chronology of Drugs for HBV

  9. AASLD Rx. Guidelines

  10. Standard Threrapy for HBV

  11. HBV Drugs - Dosage

  12. Comparison of Oral Antivirals

  13. Medications and Cautions

  14. Treatment Algorithm HBeAg +ve HBV DNA, ALT HBV Serology panel Obtain Baseline tests

  15. Treatment Algorithm HBeAg -ve HBV DNA, ALT HBV Serology panel Obtain Baseline tests

  16. Adverse Effects Endocrine Hypothyroidism Hyperthyroidism Dermatologic Rash, Dry skin, Pruritus Thinning of Hair Gastrointestinal Anorexia, Nausea, Weight loss Systemic Fever (low grade), Fatigue Myalgia and or Arthralgia Mood Disturbances Depression Irritability, Insomnia Hematologic Neutropenia, Anemia Thrombocytopenia

  17. Response to Antiviral Treatment

  18. Response at 1 Year of Rx.

  19. Clinical “Cure” Rates

  20. Seroconversion Rates

  21. Clearance of HBV DNA

  22. Peg Interferon v/s Interferon

  23. HBeAg Status and HBV DNA Clearance

  24. HBeAg Status and HBV DNA Clearance

  25. Tenofovir v/s Adefovir

  26. Entacavir v/s Lamivudine

  27. Telbivudine v/s Lamivudine

  28. Combined Treatment Regimen

  29. Drug Resistance Profile

  30. Relapses after Antiviral Rx.

  31. Incidence of HCC 105 copies/ml (20,000 IU/ml)

  32. Newer Approaches • Emtricitabine • Clevudine (l-FMAU) • Therapeutic vaccines

  33. Thank You All

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