Description
This webinar will provide a comprehensive overview of the clinical evaluation and management of Hepatitis B and C, two major causes of chronic liver disease worldwide. It will cover current diagnostic strategies, including serological and molecular testing, along with staging of liver disease. The session will also focus on evidence-based treatment approaches, including antiviral therapies and patient selection. Practical case-based discussions will help clinicians navigate real-world challenges in management. Emphasis will be placed on early detection, prevention of complications, and improving long-term patient outcomes. Ideal for physicians, gastroenterologists, and healthcare professionals involved in liver disease management.
Summary Listen
- Acute hepatitis A and E are typically self-limiting, requiring supportive care. Avoid liver-damaging medications. Monitor for fulminant hepatic failure, indicated by elevated INR and altered mental status, which necessitates transfer to a transplant center. Chronic hepatitis E in immunocompromised patients is managed with immunosuppression reduction and ribavirin, avoiding ribavirin in pregnancy due to teratogenic effects.
- Hepatitis C evaluation involves CBC, LFT, PT/INR, RFT, HCV RNA quantification, and ultrasound. Low platelets, elevated INR, or SGOT > SGPT raise suspicion for fibrosis, warranting a fibroscan. Treatment aims for undetectable HCV RNA.
- Hepatitis C treatment options include glecaprevir/pibrentasvir (8 weeks, with food) or sofosbuvir/velpatasvir (12 weeks). Achieve end-of-treatment response with undetectable HCV RNA. Sustained virologic response (SVR) 12 weeks post-treatment equals cure. Patients with pre-existing fibrosis require HCC surveillance.
- Hepatitis B management distinguishes between HBeAg-positive and -negative chronic infection versus chronic hepatitis. Treatment is generally indicated for chronic hepatitis (elevated ALT/AST, liver disease activity) and avoided for chronic infection (normal ALT/AST, minimal liver damage). Family members should be tested and vaccinated if negative.
- Preferred hepatitis B treatments are entecavir, tenofovir disoproxil fumarate (TDF), or tenofovir alafenamide (TAF). Monitor ALT/AST and viral load reduction (at least one log decrease) within three months. Follow-up every 3-6 months includes LFTs, HBeAg status (if initially positive), viral load, and ultrasound.
- HBeAg-positive patients may discontinue treatment after HBeAg seroconversion and undetectable HBV DNA for 12 months of consolidation therapy (non-cirrhotic). Discontinuation in HBeAg-negative patients is generally not recommended due to high recurrence rates. Cirrhotic patients require lifelong antiviral therapy.
- Pregnant women should be screened for HBsAg in the first trimester. Women without advanced fibrosis may delay treatment. Those with advanced fibrosis or high viral load (over one lakh IU/mL by weeks 24-28) should start tenofovir until 12 weeks postpartum. Breastfeeding is not contraindicated.
- Prevent mother-to-child transmission with maternal antiviral treatment and infant vaccination/HBIG within 24 hours. Unvaccinated individuals exposed to HBV should receive HBIG and vaccination. Check anti-HBs titers to assess immunity; consider a booster if <100 IU/L, especially for high-risk individuals.
Sample Certificate
About the Speakers
Dr. K. S. Soma Sekhar Rao
Senior Consultant Gastroenterologist and Hepatologist and Clinical Director Yashodha Hospitals, Hyderabad
Financial Disclosure
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