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

Dr. Ghany 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

Anna S. Lok

Kumar Visvanathan

Key:

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Introduction
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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
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Open to view video. Presenter: Kyong-Mi Chang
Treatment-related flares
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Open to view video. Presented: Henry Chan
Panel Discussion/Q&A
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Session II: Flares in Special Situations
Treatment withdrawal flares
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Open to view video. Presenter: Harry Janssen
Reactivation flares
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Open to view video. Presenter: Anna Lok
Pregnancy-related flares
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Open to view video. Presenter: Kumar Visvanathan
Panel Discussion/Q&A
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Final Evaluation
Final Evaluation
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