Treatment for Chronic Hepatitis B

Treatment for Chronic Hepatitis B
Screening for Hepatocellular Carcinoma
Presentation by:Mindie H. Nguyen, MD, MAS
Assistant Professor of Medicine
Division of Gastroenterology & Hepatology
Stanford University Medical Center

Chronic Hepatitis B
HBV Disease Burden in Asian-Americans
Hepatitis B Prevalence
Etiology of HCC in Asians
Impact of HBV DNA and ALT Levels on Disease Outcomes
Disease Progression and HCC Risk
Impact of Viral Load
* High viral load:
* Reduction in viral load:
HBV DNA Associated with Increased Risk of HCC
HBV DNA levels and Risk of Cirrhosis and HCC REVEAL-HBV Study
HBV DNA Levels Predict Risk of Developing Cirrhosis
Viral Load Is the Main Predictor of Cirrhosis Regardless of Serum ALT
HBV DNA Levels Predict Risk of Developing HCC
Dose-Response Relationship:
HBV DNA and HCC
HBV DNA Levels are Associated With Clinical Outcomes (HCC)
REVEAL-HBV Study: Cirrhosis Analysis Conclusions
REVEAL-HBV Study: HCC Analysis Conclusions
Impact of Treatment on Disease Progression
Primary Goal of Treatment
Rapid and sustained suppression of HBV to the lowest possible level1,2 Outcomes
Rapid and Profound HBV Suppression: an Important Therapeutic Goal
Lamivudine and Disease Progression and HCC incidence in Advanced HBV (stage III/IV)
HBV DNA Suppression Reduces Cirrhosis Progression
Lamivudine
Placebo
Diagnosis of HCC
HBV DNA Suppression Reduces HCC Incidence Rate
Conclusions
Summary

* HBV DNA is an essential marker for predicting risk for complications
* Viral suppression is associated with improved treatment outcomes in patients with advanced fibrosis.
* Emerging potent antiviral therapies provide the potential for more effective treatment response and prevention of complications of CHB

Screening for Hepatocellular Carcinoma
Screening for HCC Consensus Recommendations
HCC: Screening Tests
Changes in sensitivity and specificity of AFP for diagnosis of HCC using various cut-offs
WHO Principles of Screening
Screening improves survival
HCC Screening: clinical studies
Pseudo-Disease
RCT for HCC Screening
Cost-Effectiveness of Screening: Other Cancers
Cost-Effectiveness of HCC Screening
Real-life studies with cost information:
Screening for HCC: Summary

Treatment for Chronic Hepatitis B.ppt