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.  

Marc G. Ghany

Marc G. Ghany, MD, MHSc, FAASLD is an Investigator at the Liver Diseases Branch of the National Institute of Diabetes and Digestive and Kidney Diseases, and at Warren Grant Magnuson Clinical Center, National Institutes of Health, Bethesda. He is member the Physician Consortium for Practice Improvement for Hepatitis C, which is jointly sponsored by the American Medical Association and AASLD and serves on the hepatitis C Guidance panel which is jointly sponsored by the AASLD and Infectious Diseases Society of America. His work has been honored with the Regal Award for Excellence in Gastrointestinal and Liver Disease and with several NIDDK service awards including the Director’s Award. He received his M.B. and B.Ch. from the Royal College of Surgeon’s, Dublin, and Master of Health Sciences in Clinical Research, Duke University. He completed residency at the Hospital of Saint Raphael, New Haven, Connecticut, a fellowship in gastroenterology at Tulane University, New Orleans, and a clinical fellowship at the Liver Diseases Section, NIDDK. Dr. Ghany’s focus is on translational research to improve the care and treatment outcomes of patients with chronic viral hepatitis. 

 

Kyong-Mi Chang

Dr. Kyong-Mi Chang is an Associate Professor of Medicine in the Division of Gastroenterology at the University of Pennsylvania Perelman School of Medicine, with administrative leadership role as the Associate Chief of Staff and Associate Dean for Research at the Philadelphia Corporal Michael J. Crescenz VA Medical Center (CMC VAMC). Dr. Chang received her MD and Internal Medicine residency training from the Medical College of Pennsylvania, followed by clinical GI fellowship training at the University of California in San Diego, also receiving her postdoctoral research training at the Scripps Research Institute studying CTL escape in HCV persistence. She has been a faculty member in GI Division at the University of Pennsylvania School of Medicine and the CMC VAMC since 1999 with active clinical and research activities. Her translational research focuses on immune pathogenesis in human hepatitis C and B virus infection with and without HIV coinfection—including various immune regulatory mechanisms such as FoxP3+ Tregs, IL-10+ Tr1 cells, gdT-cells, PD-1 and CTLA-4. Dr. Chang is also participating in the Million Veteran Program—a multi-center VA genomic study. She is a Fellow of the American Association for Study of Liver Disease (FAASLD) and a member of the American Society for Clinical Investigation (ASCI).

Henry Chan

Harry Janssen

Harry Janssen, MD, PhD, FAASLD is a professor of medicine at the University of Toronto, Ontario, Canada, where he holds the Francis Family Chair in hepatology. He currently works at Toronto General Hospital as chief of hepatology and director of the Toronto Centre for Liver Disease.

Dr. Janssen graduated from medical school in the Netherlands. During his study he spent one year as research student in Hepatology at the Mayo Clinic. He obtained his PhD in Rotterdam on the role of immune modulating therapy in hepatitis B. Following his training in Internal Medicine and Gastroenterology in the Netherlands, he returned to the Mayo Clinic for a Research Fellowship in Hepatology. In 2001, he became a faculty member and in 2006 he was appointed as full professor of medicine and chief of the Section Liver Diseases and Transplantation in Rotterdam. In 2013, he came to Canada where he merged three liver programs into the Toronto Centre for Liver Disease, based at the Toronto General Hospital, University Health Network.

Dr. Janssen has coordinated numerous clinical and translational studies on treatment for chronic viral hepatitis and other liver diseases. His main research interest is cure of chronic hepatitis B. He has published more than 500 original peer-reviewed papers and many book chapters. His H-index is over 100 and he has been cited 45,000 times (Google Scholar). He has received several prestigious international awards and has mentored over 50 PhD students, of whom many have taken leadership positions in the field of hepatology or virology.

Anna S. Lok

Kumar Visvanathan

Key:

Complete
Failed
Available
Locked
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
4 Questions
4 Questions Please complete the following evaluation form to share your feedback on this activity.