Hepatitis B SIG: HBV Flares: Distinguishing the Good from the Bad

5 (1 vote)

Recorded On: 11/11/2018

Chronic HBV (CHB) infection follows a dynamic course with multiple phases of disease with various durations.  ALT flares during CHB can be challenging for clinicians to manage.  In some settings ALT flares herald a transition from active to inactive disease and thus are considered to be beneficial. In other scenarios, they may indicate aggressive inflammatory liver disease than can lead to progressive liver injury or even fulminant hepatic failure. Understanding and distinguishing these 'good' and 'bad' flares is not only a clinical challenge but a key to understanding the natural history and the therapeutic goals of HBV treatment. The program starts with a definition of flares and the current understanding of their immunological pathophysiology. Flares in different clinical settings will also be discussed (focusing on their beneficial and potentially harmful effects). Finally, attendees will hear about management strategies for ATL flares.  

Naga P. Chalasani

Naga P. Chalasani, MD, FAASLD currently serves as David W. Crabb Professor of Medicine and Interim Chair of the Department of Medicine at Indiana University School of Medicine. He previously served as the Director of the Division of Gastroenterology and Hepatology at the same institution from 2007 to 2020.   He completed his medical education in India and subsequently completed Internal Medicine Residency and Gastroenterology and Hepatology subspecialty training at Emory University in Atlanta. His research interests include CYP450 enzymes and liver disease and hepatic safety of xenobiotics. His research has been continuously funded by the National Institutes of Health since 1999.  He is currently the PI for three U01 awards and an R01 award from the National Institutes of Health. He published over 300 original papers, 3 Practice Guidelines, 47 book chapters/review articles, 31 editorials/commentaries, 16 symposium proceedings, and more than 500 abstracts. He is the lead author for the AASLD Practice Guideline on the Diagnosis and Management of Nonalcoholic Fatty Liver Disease and is the lead author on the ACG Practice Guideline on the Diagnosis and Management of Drug Induced Liver Injury. He is an elected member of the American Society of Clinical Investigation (ASCI) and the American Association of Physicians (AAP).

Kyong-Mi Chang

Kyong-Mi Chang, MD is Professor of Medicine in GI/Hepatology, University of Pennsylvania Perelman School of Medicine, with administrative leadership role as the Chief of Staff and Associate Dean for Research at the Corporal Michael J. Crescenz Veterans Affairs Medical Center in Philadelphia PA.

Dr. Chang is a translational investigator with expertise in immune pathogenesis of human viral hepatitis B and C. Dr. Chang received M.D. and Internal Medicine residency training from the Medical College of Pennsylvania, GI fellowship training at the University of California San Diego and postdoctoral research training in viral immune pathogenesis at the Scripps Research Institute. Since the mid 90’s, Dr. Chang has examined distinct patient cohorts using state-of-the-art immunological methods and novel tools to identify immune and viral mechanisms of liver disease pathogenesis in patients with acute and chronic hepatitis B or C. Chang lab was the first to apply high dimensional imaging mass cytometry visualization of HBV-infected liver tissues, identifying close correlations between innate and adaptive immune parameters with hepatocellular injury and fibrosis. Dr. Chang has also been examining genetic underpinnings of metabolic liver disease in the VA’s Million Veteran Program (MVP). Finally, Dr. Chang has been a member of the AASLD for over 2 decades, serving in various committees and meetings--currently as Chair of HBV SIG Basic Science Subcommittee. 

Henry Chan

Paul H. Hayashi

Paul “Skip” H. Hayashi, MD, MPH, FAASLD is an adult hepatologist at the FDA.  He is DILI Team Lead in the Division of Hepatology and Nutrition, Office of New Drugs, Center for Drug Evaluation and Research.  Prior to joining the FDA in February of 2020, he held positions in academia, civil service and uniformed service.  He received his BA in microbiology at University of California (UC) Los Angeles and medical degree at UC San Diego.  After completing residency and gastroenterology fellowship at UC Davis, he completed a clinical research fellowship in the Liver Diseases Section, National Institutes of Health, Bethesda, MD as a public health officer.  He then returned to California as Assistant Professor at the Veterans Administration Hospital in Loma Linda, California followed by serving in the US Air Force Medical Corp in Japan and Texas. While in the Air Force he continued clinical research, and then returned to academia by completing a transplant fellowship at the University of Colorado, Denver.  He then served as Assistant Professor and transplant hepatologist at Saint Louis University (SLU), St. Louis, Missouri.  In 2006, he completed a Master of Public Health at SLU.   From 2006, he was Medical Director of Liver Transplantation at the University of North Carolina (UNC), Chapel Hill, and became a Professor of Medicine at UNC before joining the FDA in 2020.  Since 2007, he has been a Co-Principle Investigator in the US Drug-Induced Liver Injury Network (DILIN) and remains Co-Chair of the DILIN’s Causality Committee.  

Anna S. Lok

Kumar Visvanathan

Key:

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Introduction
Open to view video.
Open to view video.
Session I: The Basics of Flares
Prevalence and definitions of HBV flares in the natural history of chronic infection
Open to view video.
Open to view video. Presenter: Marc Ghany
Immunology of HBV flares
Open to view video.
Open to view video. Presenter: Kyong-Mi Chang
Treatment-related flares
Open to view video.
Open to view video. Presented: Henry Chan
Panel Discussion/Q&A
Open to view video.
Open to view video.
Session II: Flares in Special Situations
Treatment withdrawal flares
Open to view video.
Open to view video. Presenter: Harry Janssen
Reactivation flares
Open to view video.
Open to view video. Presenter: Anna Lok
Pregnancy-related flares
Open to view video.
Open to view video. Presenter: Kumar Visvanathan
Panel Discussion/Q&A
Open to view video.
Open to view video.
Final Evaluation
Final Evaluation
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