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WHAT TO DO AFTER
DIAGNOSIS
Scope of Discussion
Aims of monitoring
Measurements to monitor
Frequency of monitoring
Summary of recommendations
Active
hepatitis B
viral replication:
HBeAg+
HBV DNA > 5 logs copies or 20000 units/ml
Immune clearance:
Cirrhosis:
Decompensation:
Development of:
Infection
Others
Immune complex diseases
Likelihood:
HCC:
50x to 200x
Through cirrhosis or direct carcinogenic effect of the virus.
Risk increase with higher HBV DNA levels.*
Other factors includes genotype, age of patient and alcohol
consumption.
Treatment with reduction in HBV DNA reduces risk of HCC
development.^
*Cleve Clin J Med. 2009 May;76 Suppl 3:S6-9.Risk of hepatocellular carcinoma in hepatitis B and prevention through treatment.Sherman M.
^N Engl J Med. 2004 Oct 7;351(15):1521-31.Lamivudine for patients with chronic hepatitis B and advanced liver disease.Liaw YF et al
Cirrhosis
Increases with increase duration of active disease.
2 to 5.4 per 100 person years with a 5-year cumulative incidence
of cirrhosis of 8% to 20% .^
Mortality rate at 5 years is 16% for those with compensated
cirrhosis and is 65% to 86% for decompensated cirrhosis.#
Death:
^Fattovich G. Natural
history of hepatitis B. Journal of Hepatology. 2003 ;39:S50-S58
*N Engl J Med. 2004 Oct 7;351(15):1521-31.Lamivudine for patients with chronic hepatitis B and advanced liver disease.Liaw YF et al
Ascites:
Varices:
HCC:
< 5 cm
CTP A
Anatomical considerations
HCC:
Measurements to Monitor
liver/abdomen
For decompensation:
Albumin
Bilirubin
INR
Measurements to Monitor
Frequency of Monitoring
Advance cirrhosis
Frequency of Monitoring
3 to 6 monthly screening.
To do blood test and ultrasound of the abdomen at the
same time.
Proceed to other modalities of investigations only if
the above tests are abnormal.
Summary of Recommendations
Chronic hepatitis B is a chronic illness with
significant morbidity and mortality.
Early institution of appropriate treatment can
result in an improved outcome.
Regular follow-up is an established way to
detect complications early.
Summary of Recommendations
Most physicians will review their patients 3 to 6
monthly.
Each review will require the patients to have
LFT
AFP
Ultrasound of abdomen
Thank You