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eViralHepatitis Review VOLUME
2, ISSUE 9
Reactivation of Hepatitis B Virus Infection
In this Issue...
Hepatitis B virus (HBV) reactivation occurs when there is a loss of immune control, leading to a recurrence of or abrupt rise in HBV replication in a previously inactive chronic carrier. Clinically, reactivation can range from asymptomatic hepatitis to fulminant liver failure. The risk for HBV reactivation is likely dependent on a patient’s baseline degree of immune control, as well as on the strength and duration of the immunosuppression used. The severity of liver disease–that is, the degree of liver fibrosis prior to undergoing chemotherapy–probably plays a role in how well a patient can tolerate HBV reactivation. Prophylactic treatment with antiviral therapy can be lifesaving in individuals experiencing HBV reactivation. The treatment approach in certain clinical situations is clear–for example, initiating prophylactic therapy in a patient positive for hepatitis B surface antigen (HBsAg) who has lymphoma and is undergoing rituximab-containing chemotherapy. As the use of immunosuppressive regimens expands and the underlying hepatitis B viral state becomes better defined, however, many clinical situations arise for which the benefit of prophylactic therapy is unknown.
In this issue, we review recent publications that describe the diverse clinical settings in which HBV reactivation can occur, the risk for reactivation in patients with resolved and occult HBV infection, and the success of different treatment approaches.
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LEARNING
OBJECTIVES
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After completing this activity, the participant will demonstrate the ability to:
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Summarize the wide range of clinical settings in which the risk for hepatitis B virus (HBV) reactivation should be considered |
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Describe the risk for HBV reactivation in hepatitis B surface antigen (HBsAg)-negative patients |
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Evaluate the success of various treatment regimens and approaches to preventing HBV reactivation
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The Johns Hopkins University School of Medicine takes responsibility for the content, quality, and scientific integrity of this CME activity.
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IMPORTANT CME/CE INFORMATION |
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Accreditation Statements
Physicians
This activity has been planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of The Johns Hopkins University School of Medicine and The Institute for Johns Hopkins Nursing. The Johns Hopkins University School of Medicine is accredited by the ACCME to provide continuing medical education for physicians.
Nurses
The Institute for Johns Hopkins Nursing is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation.
The Institute for Johns Hopkins Nursing and the American Nurses Credentialing Center do not endorse the use of any commercial products discussed or displayed in conjunction with this educational activity.
credit designations Physicians eNewsletter: The Johns Hopkins University School of Medicine designates this enduring material for a maximum of 1.0 AMA PRA Category1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Podcast: The Johns Hopkins University School of Medicine designates this enduring material for a maximum of 0.5 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Nurses eNewsletter: This 1 contact hour Educational Activity is provided by The Institute for Johns Hopkins Nursing. Each newsletter carries a maximum of 1 contact hour or a total of 7 contact hours for the 7 newsletters in this program.
Podcast: This 0.5 contact hour Educational Activity is provided by the Institute for Johns Hopkins Nursing. Each podcast carries a maximum of 0.5 contact hour or a total of 2.5 contact hours for the 5 podcasts in this program.
successful completion To successfully complete this activity, participants must read the content, and then link to the
Johns Hopkins University School of Medicine's website or the Institute for Johns Hopkins Nursing’s website to complete the post-test and evaluation. Once you receive a passing grade, you can access and print your certificate of credit.
NOTE: If you have already registered for other Hopkins CME programs on their prospective websites simply enter the requested information when prompted.
There are no prerequisites for this activity.
This activity is supported by an educational grant from Gilead Sciences, Inc. and Vertex Pharmaceuticals.
Launch Date January 31, 2012; activities expire 2 years from the date of publication.
STATEMENT OF NEED; Central ideas emerged from our needs assessment. In order to provide optimal treatment to patients with viral hepatitis
Clinicians do not effectively identify their patients
at risk for, or infected with, HBV
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Clinicians lack the ability to interpret positive HBV
screening and do not adequately counsel their patients re: their HBV status (for treatment or vaccination) |
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Clinicians do not properly treat, monitor, or refer
their patients with viral hepatitis and moreover, they lack awareness of current treatments and emerging research |
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Clinicians require more evidence on tailoring HCV
treatments to manage treatment side effects more effectively |
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Clinicians require more evidence-based information
to manage antiviral treatment more effectively in co-infected patients |
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Internet CME Policy
The Office of Continuing Medical Education (CME) at the Johns Hopkins University School of Medicine is committed to protecting the privacy of its members and customers.
The Johns Hopkins University SOM maintains its Internet site as an information resource and service for physicians, other health professionals, and the public.
Continuing Medical Education at the Johns Hopkins University School of Medicine will keep your personal and credit information confidential when you participate in an Internet-based CME program.
Your information will never be given to anyone outside of the Johns Hopkins University School of Medicine program. CME collects only the information necessary to provide you with the services that you request.
Disclaimer Statement
The opinions and recommendations expressed by faculty and other experts whose input is included in this program are their own. This enduring material is produced for educational purposes only.
Use of the Johns Hopkins University School of Medicine name implies review of educational format design and approach. Please review the complete prescribing information for specific drugs or combinations of drugs, including indications, contraindications, warnings, and adverse effects, before administering pharmacologic therapy to patients.
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Statement of Responsibility The Johns Hopkins University School of Medicine takes responsibility for the content, quality, and scientific integrity of this CME activity.
Intended Audience This activity has been developed for hepatologists, primary care physicians, infectious disease specialists, nurses, nurse practitioners, and others involved in the care of patients with viral hepatitis.
Planner Disclosure As a provider accredited by the Accreditation Council for Continuing Medical Education (ACCME), it is the policy of the Johns Hopkins University School of Medicine Office of Continuing Medical (OCME) to require signed disclosure of the existence of financial relationships with industry from any individual in a position to control content of a CME activity sponsored by OCME.
Members of the Planning Committee are required to disclose all relationships, regardless of their relevance to the activity content. Faculty are required to disclose only those relationships that are relevant to their specific presentations. The following relationships have been reported for this activity:
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Mark S. Sulkowski, MD, has disclosed that he has served as a consultant for Abbott, Boehringer Ingelheim Pharmaceuticals, Inc., Bristol Myers-Squibb, Gilead, Janssen, Merck, Novartis, Pfizer, Roche, and Vertex Pharmaceuticals. He also has received grants and research support from, Abbott, Boehringer Ingelheim Pharmaceuticals, Inc., Bristol Myers-Squibb, Gilead, Janssen, Merck, and Roche, and Vertex Pharmaceuticals. |
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Raymond T. Chung, MD, has disclosed that he has received grants/research support from Gilead, Pfizer, Roche/Genentech, Merck, and Romark. |
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No other planners have indicated that they have any financial interests or relationships with a commercial entity. |
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Guest
Authors Disclosures |
Confidentiality Disclaimer for Conference Attendees I certify that I am attending a Johns Hopkins University School of Medicine CME activity for accredited training and/or educational purposes.
I understand that while I am attending in this capacity, I may be exposed to "protected health information," as that term is defined and used in Hopkins policies and in the federal HIPAA privacy regulations (the Privacy Regulations). Protected health information is information about a person's health or treatment that identifies the person.
I pledge and agree to use and disclose any of this protected health information only for the training and/or educational purposes of my visit and to keep the information confidential.
I understand that I may direct to the Johns Hopkins Privacy Officer any questions I have about my obligations under this Confidentiality Pledge or under any of the Hopkins policies and procedures and applicable laws and regulations related to confidentiality.
The contact information is Johns Hopkins Privacy Officer, telephone: 410-735-6509, e-mail: HIPAA@jhmi.edu.
"The Office of Continuing Medical Education at The Johns Hopkins University School of Medicine, as provider of this activity, has relayed information with the CME attendees/participants and certifies that the visitor is attending for training, education and/or observation purposes only."
For CME Questions, please contact the CME Office at (410) 955-2959 or e-mail cmenet@jhmi.edu.
For CME Certificates, please call (410) 502-9634.
Johns Hopkins University School of Medicine
Office of Continuing Medical Education
Turner 20/720 Rutland Avenue
Baltimore, Maryland 21205-2195
Reviewed and Approved by
General Counsel, Johns Hopkins Medicine (4/1/03)
Updated 4/09
Hardware & Software Requirements Pentium 800 processor or greater, Windows 98/NT/2000/XP/7 or Mac OS 9/X, Microsoft Internet Explorer 5.5 or later, 56K or better modem, Windows Media Player 9.0 or later, 128 MB of RAM, sound card and speakers, Adobe Acrobat Reader, storage, Internet connectivity, and minimum connection speed. Monitor settings: High color at 800 x 600 pixels.
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GUESTS
AUTHORs OF THE MONTH
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Commentary:
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David Wong, MD
Assistant Professor of Medicine
University Health Network
University of Toronto
Toronto, Ontario, Canada |
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Aviva Leber, MD
Gastroenterology Fellow
University Health Network
University of Toronto
Toronto, Ontario, Canada |
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Guest
Faculty Disclosures
No faculty members have indicated that they have any financial interests or relationships with a commercial entity whose products or services are relevant to the content of their presentations.
Unlabeled/Unapproved Uses
The authors have indicated that there will be references to unlabeled or unapproved uses of lamivudine, entecavir, and tenofovir for HBsAg negative/HBcAb positive/HBsAb negative patients undergoing significant immunosuppression.
Program
Directors’ Disclosures
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TO ACCESS THE
POST-TEST
Step
1.
Review the CE Information and study the educational content.
Step
2.
Click the post-test link at the end of the newsletter.
Step
3.
Follow the instructions to access a post-test.
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