Latest Updates

• New AASLD guidance on diagnosis and management of key HBV coinfections (ie, HIV, HCV, or HDV)
• Updated discussion of HBV management before, during, and after pregnancy
• New AASLD guidance on HBV management in patients at risk for HBV reactivation, including those slated for immunosuppressive or cytotoxic therapy

• New prevalence data on HDV hot spot Mongolia
• Updated information on HDV detection methodology and standardization
• New guidance from the AASLD on treatment of HDV infection
• Updated discussion of novel therapies for HDV

• New AASLD HBV guidance, including the recommendation of tenofovir AF as a first-line oral monotherapy option for patients with chronic hepatitis B
• Updated discussion of HBsAg seroclearance as a valuable treatment endpoint during nucleos(t)ide analogue treatment
• Long-term survival data support extended use of entecavir or tenofovir DF
• New discussion on risk of HCC and progression to cirrhosis in chronic hepatitis B
• Adding peginterferon alfa-2a to entecavir results in longer off-treatment sustained responses vs entecavir monotherapy for HBeAg-positive but not HBeAg-negative disease
• Updated recommendations regarding options for treatment modification in the case of suboptimal response

• Updated data on global prevalence of HCV infection
• New data on HCV transmission via organ transplant from seropositive, NAT-negative donors
• Updated IDU prevalence rates and reinfection risk estimates
• Recent studies on HCV sexual transmission highlight risk factors among women sex workers and MSM
• New data on HCV seroprevalence and reinfection risk among incarcerated persons
• Latest risk-based guidance on anti-HCV screening
• HCV testing algorithm for follow-up of individuals testing anti-HCV positive
• Currently available assays for HCV RNA detection and guidance on interpreting assay results
• Recent data on risk factors for and rate of liver biopsy-associated complications
• Updated data on primary HCV infection in the United States

• Revised AASLD/IDSA guidance on HCV management in patients with advanced renal disease
• New recommendations on diagnosis, surveillance, and management of children with chronic HCV infection have been issued by the AASLD/IDSA in their most recent guideline update
• The section on diagnosis, surveillance, and management of HCV in pregnancy has been expanded and updated
• Updated AASLD/IDSA guidance on HCV treatment in patients with HIV coinfection incorporates newly approved regimens
• New guidance from the AASLD/IDSA on patients with decompensated cirrhosis or post liver transplantation are included in the module

• DAA dose adjustments for patients with renal impairment updated to reflect FDA approval of sofosbuvir/velpatasvir/voxilaprevir and glecaprevir/pibrentasvir for the treatment of adults with genotype 1-6 HCV infection
• New clinical trial results assessing glecaprevir/pibrentasvir in patients with renal impairment
• Glecaprevir in combination with pibrentasvir approved by the FDA for the treatment of genotype 1 HCV/HIV coinfection
• New clinical trial results assessing glecaprevir/pibrentasvir in patients with genotype 1 HCV/HIV coinfection
• Glecaprevir in combination with pibrentasvir approved by the FDA for the treatment of genotype 2-6 HCV/HIV coinfection
• New clinical trial results assessing glecaprevir/pibrentasvir in patients with genotype 2-6 HCV/HIV coinfection
• Safety profile of glecaprevir/pibrentasvir in patients with genotype 1-6 HCV/HIV coinfection
• Drug–drug interactions for glecaprevir/pibrentasvir in patients with genotype 1-6 HCV/HIV coinfection

• Tenofovir alafenamide joins tenofovir disoproxil fumarate and entecavir in EASL HBV guidelines as a recommended first-line oral monotherapy option for patients with chronic hepatitis B

• Ledipasvir/sofosbuvir approved by the FDA for adolescent patients with genotype 1, 4, 5, or 6 HCV infection
• Sofosbuvir in combination with ribavirin approved for adolescent patients with genotype 2 or 3 HCV infection

• New EASL guidance on management of HBV in patients coinfected with HBV and HIV
• New guidance from AASLD and EASL on the management of HBV reactivation in HBV/HCV-coinfected patients
• New EASL guidance on the management of HBV in women of childbearing age, including status of tenofovir AF
• Latest recommendations on monitoring patients at risk of HBV reactivation

• New discussion on tenofovir alafenamide fumarate including data on noninferiority to tenofovir disoproxil fumarate
• Combination of peginterferon alfa-2a with tenofovir DF demonstrated a significantly higher rate of HBsAg loss after 48 weeks of treatment vs peginterferon monotherapy, but seroreversion after discontinuation attenuated initial differences
• Adding tenofovir DF to entecavir showed similar rates of HBV DNA < 15 IU/mL compared with tenofovir DF alone in patients with documented entecavir resistance 
• New discussion on adding or switching to peginterferon alfa-2a following nucleo(s)tide therapy
• Updated with current guidance from the 2016 Asian-Pacific consensus statement 

• Revised to reflect the latest guidance on management of HCV/HIV coinfection from the AASLD/IDSA, DHHS, and EASL
• C-SURFER study establishes safety and efficacy of elbasvir/grazoprevir in patients with stage 4/5 chronic kidney disease and genotype 1 HCV infection
• Preliminary results from phase II trials have shown safety and efficacy in adolescent patients with ledipasvir/sofosbuvir in genotype 1 HCV infection or sofosbuvir plus ribavirin in genotype 2 or 3 HCV infection
• Results from C-EDGE and ASTRAL-5 trials on safety and efficacy of elbasvir/grazoprevir or sofosbuvir/velpatasvir in HCV/HIV coinfection
• New information on drug–drug interactions with elbasvir/grazoprevir and sofosbuvir/velpatasvir in patients with HCV/HIV coinfection
• GALAXY study shows high SVR12 rates with simeprevir plus sofosbuvir in posttransplantation patients with genotype 1 HCV infection

• Updated guidance from the AASLD on management of chronic HBV infection

• New guidance from the AASLD on the use of antiviral therapy during the third trimester of pregnancy for the prevention of perinatal HBV transmission in HBsAg-positive women 

• FDA prescribing information for ombitasvir/paritaprevir/ritonavir-based regimens revised to include contraindication in patients with moderate to severe hepatic impairment

• Updated with new guidance from Public Health England on screening for HEV
• Included updated epidemiologic data on HAV from the CDC
• Included updated epidemiologic data on HEV the National Health and Nutrition Examination Survey
• Updated with guidance from the CDC on use of hepatitis A adult vaccine as postexposure prophylaxis
• Included new data on the long-term efficacy of the HEV 239 vaccine

• New phase III trials of brincidofovir vs valganciclovir for prevention of CMV in kidney transplant recipients
• New data on a live attenuated varicella vaccine
• New phase III trial of brincidofovir for treatment of adenovirus infection
• New data on pleconaril in neonates with enterovirus sepsis
• New data on a tetravalent dengue vaccine
• Updated information on candidate treatments and vaccines for Ebola

• Revised AASLD/IDSA guidance on HCV management in patients with advanced renal disease 
• Updated AASLD/IDSA guidance on HCV treatment in patients with HIV coinfection incorporates newly approved regimens

• Several studies show viral suppression with nucleos(t)ide analogues may reduce but not eliminate risk of HCC, especially in patients with cirrhosis
• Combination tenofovir plus emtricitabine more effective than tenofovir alone in patients with HBeAg-positive disease with high viral load and low ALT
• Data suggest treatment with nucleo(s)tide analogues associated with good renal and bone safety profiles
• Recent data show only 70% HBV treatment adherence, and younger patients more likely to be nonadherent

• Included new guidance from the American Gastroenterological Association on the prevention and treatment of HBV reactivation in patients receiving immunosuppressive therapy
• Updated with current guidance from the EACS and DHHS on treatment of HBV/HIV coinfected patients
• Updated with new recommendations on the treatment of HBV/HCV coinfection

• References reviewed and updated to reflect recent publications

• Daclatasvir in combination with sofosbuvir FDA approved for the treatment of genotype 3 HCV infection
• Ombitasvir/paritaprevir/ritonavir in combination with ribavirin FDA approved for the treatment of genotype 4 HCV infection
• Updated to reflect current recommendations by the AASLD-IDSA on the treatment of HCV infection in special populations

• Updated global epidemiologic data from the CDC
• Data suggesting rate of reinfection among IDUs low after treatment with antiviral therapy
• Interferon-free regimens provide means of treating HCV-related autoimmune conditions with contraindications to interferon
• Study suggesting no association between HCV and diabetes in US population
• New data demonstrating predominant role of host genetic variants in MHC in accelerated liver fibrosis
• Updated to reflect current guidance from EASL

• Updated to reflect most recent recommendations from the EASL, EACS, DHHS, and AASLD-IDSA guidelines panels

• Updated discussion on HCV therapeutic targets

• Updated to reflect recent epidemiologic data from the 2013 CDC Surveillance for Viral Hepatitis report
• New data showing most cases of HBV in the US and Canada are in patients born outside of North America
• New data from Taiwan and Germany showing HBV prevalence remains high
• Previously vaccinated healthcare workers with low levels of anti-HBs have a rapid and robust response to booster vaccine, a finding that supports the recommendation that booster doses are not required in persons with normal immune systems
• National and international guidelines recommend HBV screening to patients initiating immunosuppressive therapy to prevent reactivation

• Updated with new epidemiologic data in Taiwan, Iran, China, and Italy
• New discussion on promising emerging therapies for HDV

• Revised guidance for AASLD/IDSA on diagnosis of acute HCV infection

• Updated to reflect current guidance from the APASL on the management of hepatitis B
• Updated epidemiologic data from the WHO
• New data demonstrate efficacy of using tenofovir alone in patients with lamivudine resistance
• New discussion of the risk of hepatocellular carcinoma in patients with decompensated cirrhosis receiving treatment for 5 years
• New section summarizing key roles for primary care physicians in the management of patients with HBV infection

• Updated AASLD/IDSA HCV guidance recommends against coadministration of simeprevir and cyclosporine based on evidence of increased simeprevir plasma concentration when it is coadministered with cyclosporine, daclatasvir, and ribavirin

• Updated with new data suggesting host-specific rather than virus specific factors are responsible for fulminant hepatitis in patients with HEV 
• Included new data on ribavirin treatment for solid organ transplant patients with HEV 
• Included new data on the prevalence of HEV in patients with HIV awaiting solid organ transplantation
• Included new section with key information for primary care providers

• Included prevalence data of CMV disease in liver transplant patients
• Included phase 3 study on dengue virus vaccine
• Updated with new AST Infectious Diseases Guidelines on Cytomegalovirus; Epstein-Barr virus; Herpes simplex virus; HHV-6, HHV-7, HHV-8; Varicella zoster virus; Adenovirus; and Human parvovirus B19
• Included a new section with key information for primary care physicians

• Updated to include new potential therapeutic targets for hepatitis B including TLR7 stimulation, therapeutic vaccination, NCTP inhibition, and RNA interference–based strategies
• New section added summarizing clinically relevant information for primary care physicians

• Updated to include new data and statistics on HCV prevalence
• New section added with considerations for primary care physicians

• New data indicate that HDV RNA levels may be prognostic for the development of cirrhosis and hepatocellular carcinoma
• Long-term follow-up of HBV/HDV-infected patients who responded to treatment with peginterferon demonstrates a high rate of relapse over time
• New section summarizing key roles for primary care physicians in the management of HDV infection

• The latest global HBV epidemiology data indicate that west sub-Saharan Africa has the highest HBV prevalence
• Incidence of acute HBV continues to decline in the United States
• 30-year follow-up confirms continued reduction in liver-related mortality following introduction of universal HBV immunization in Taiwan
• Updated guidance from the US Preventive Services Task Force now includes recommendations for HBV screening in individuals at high risk for infection
• New data on HBsAg level changes during nucleos(t)ide analogue therapy
• New section summarizing key roles for primary care physicians in the prevention and identification of HBV infection

• Updated guidance on HCV management in the setting of renal disease includes recommendations on simeprevir and sofosbuvir dosing in patients with renal impairment
• Recent data on the safety and efficacy of ribavirin therapy in patients with renal impairment
• The latest findings on the natural history of HCV infection in children
• Comprehensive information on the latest AASLD/IDSA and EASL guidelines on optimal management of patients with HCV/HIV coinfection
• Practical information on the use of older agents in settings where guideline-recommended therapies are not yet available
• Updated data on drug-drug interactions with direct-acting antiviral agents, including simeprevir and sofosbuvir
• Revised AASLD/IDSA and EASL guideline recommendations on HCV-infected patients who are awaiting or have undergone liver transplantation
• New section summarizing key roles for primary care physicians in the management of HCV infection in patients with renal disease, patients with HIV coinfection, children, and liver transplant recipients
• European approval of simeprevir for patients infected with genotype 1 or 4 HCV

• New HCV management guidelines from EASL published in April 2014

• Interim data from the HIDIT-2 study, a randomized trial of peginterferon alfa-2a plus tenofovir or placebo for the treatment of patients with hepatitis D virus
• New long-term data on the safety and efficacy of telbivudine for preventing transmission in pregnant women
• Emerging reports suggest that there may be some benefit to early tenofovir DF treatment in pregnant women
• New data on HBV transmission rates when lamivudine is initiated in the second or third trimester of pregnancy
• New interim data on the treatment of HBsAg-negative, anti-HBc–positive patients who received rituximab-containing chemotherapy and therapeutic entecavir therapy
• Updated information on HBV recurrence rates for patients who received prophylaxis with a combination of hepatitis B immune globulin and entecavir after liver transplantation
• New data on converting patients from hepatitis B immune globulin plus a single nucleos(t)ide to a combination nucleoside–nucleotide analogue prophylaxis at least 12 months after transplantation
• Updated to include a summary of the primary care essentials

• Updated to include summaries of the American Association for the Study of Liver Diseases/Infectious Diseases Society of America 2014 guideline recommendations on treatment of chronic hepatitis C in patients with renal disease; treatment of chronic hepatitis C in HIV-infected patients; and treatment of recurrent hepatitis C in recipients of liver transplants
• EMEA approval of sofosbuvir for patients infected with chronic genotype 1-6 HCV

Updated to include revised guidelines from the AASLD/IDSA on the following topics:

• Situations where barrier protection during intercourse is recommended to prevent sexual transmission of HCV 
• HCV testing recommendations for persons with tattoos received in unregulated settings
• Counseling patients with HCV infection on measures to prevent transmission to others
• Birth cohort and risk-based screening for HCV infection
• Serologic assays for initial detection of HCV infection
• HCV RNA testing 
• Strategies for assessing liver disease in patients with HCV infection

• Reference to the American Association for the Study of Liver Diseases and Infectious Diseases Society of America 2014 guideline recommendations on treatment of chronic hepatitis C 
• EMEA approval of sofosbuvir for patients infected with chronic genotype 1-6 HCV

• FDA approval of simeprevir for treatment of genotype 1 HCV–infected patients
• FDA approval of sofosbuvir for treatment of genotype 1, 2, 3, or 4 HCV–infected patients
• New data on use of sofosbuvir in the setting of liver transplantation

• Updated to include December 2013 CDC guidance on pre- and post- HBV vaccination testing and postexposure prophylaxis for healthcare personnel

• Updated discussion of HCV therapeutic targets to include FDA approval of simeprevir for patients infected with chronic genotype 1 HCV and sofosbuvir for patients infected with chronic genotype 1-4 HCV, as well as additional drugs in advanced development.

• Journal Highlight: Hashem El-Serag, MD, MPH, comments on recent data suggesting that mortality in the United States due to liver disease–related complications has been underestimated.

• Journal Highlight: Hashem El-Serag, MD, MPH, comments on recent data suggesting that mortality in the United States due to liver disease–related complications has been underestimated

• Journal Highlight: Heiner Wedemeyer, MD, comments on the possibility of PI-based triple therapy post–liver transplantation, provided careful patient monitoring

• Updated with latest HBV epidemiologic data 
• Additional data on effectiveness of HBV vaccination in reducing prevalence of HBV 
• Discussion of 2012 cases of HBV transmission due to improper use of blood glucose–monitoring devices 

• Updated to address the potential role of iron overload in the increased severity of liver disease in patients with HBV/HDV coinfection
• Updated to reflect data suggesting that HBV/HDV coinfection may increase the risk of hepatocellular carcinoma
• Updated with new clinical trial data on the treatment of HBV/HDV coinfection and HIV/HBV/HDV coinfection

• New epidemiologic data on prevalence of HCV infection among injection drug users
• Epidemiologic data supporting the relatively low risk of sexual transmission of HCV
• A study from the CDC reporting outbreaks of HCV in the healthcare setting
• Changes in supplemental testing for HCV infection due to discontinuation of a previously recommended immunoblot assay
• New data on the use of rapid testing for HCV
• New data on HCV reinfection and liver disease progression following liver transplantation

• Updated to include new analysis of lamivudine drug-resistance mutations in patients with HBV infection
• Updated to include new evidence suggesting that iron overload may be a contributing factor in the increased severity of liver disease in HDV infection
• Updated to discuss potential therapeutic targets for HDV treatment, including HDV attachment to the liver cell and virion assembly
• Updated to include phase III clinical trial development of novel HCV regimens, including protease inhibitors, NS5A inhibitors, and NS5B polymerase inhibitors

• Video Insight: Harry L. A. Janssen, MD, PhD, discusses the potential clinical role of HBsAg loss as a treatment endpoint in HBV management
• Video Insight: Patrick Marcellin, MD, discusses the reversal of fibrosis and cirrhosis with long-term hepatitis B therapy
• Journal Highlight: Entecavir treatment is associated with a reduction in the risk of clinical events, including hepatocellular carcinoma 
• Updated to reflect an expanded indication from the FDA for tenofovir to include its use in treatment-experienced patients with documented resistance to lamivudine

• Updated with a Journal Highlight in which K. Rajender Reddy, MD, comments on the possibility of using oral nucleos(t)ide analogues without hepatitis B immunoglobulin for prevention of HBV reinfection following liver transplantation for certain patients
• New boxed warning regarding the risk of HBV reactivation with the immune-suppressing and anticancer agents ofatumumab and rituximab
• Updated with a Journal Highlight in which Fabien Zoulim, MD, PhD, comments on the risk of HBV reactivation in patients with resolved HBV infection during R-CHOP lymphoma therapy and provides monitoring and/or prophylactic antiviral therapy recommendations.

• Updates from the Antiretroviral Pregnancy Registry on the use of HBV treatments during pregnancy
• New data on the extent of HBV coinfection in persons with HCV in the United States
• New data on correlates and prevention of HBV reactivation in patients receiving immunosuppressive or cancer chemotherapy
• New data on posttransplant management of persons with chronic hepatitis B

• Recently published data regarding the incidence of late-onset cytomegalovirus (CMV) disease in liver and kidney transplant recipients
• Prevention of CMV disease in liver transplant recipients
• Possible increased risk of Burkitt’s lymphoma in solid-organ transplant recipients
• New findings on the risk of reactivation of human herpes virus 6 (HHV6) in liver transplant recipients
• New findings on the timing of the reactivation of varicella zoster virus (VZV) infection in liver transplant recipients and on the treatment of the reactivation of VZV infection in liver transplant recipients
• Recent data on the treatment of adenovirus hepatitis in liver transplant recipients
• Recent data on the transmission of parvovirus B19
• New information concerning a clinical trial of a vaccine for dengue virus

• New information on HCV natural history and predictors of outcome
• Additional information on the effects of HCV treatment on physical development in children
• New information on the effect of treatment responses on disease outcomes in HCV/HIV-coinfected patients
• New preliminary data on the use of HCV protease inhibitors in the setting of liver transplantation
• Final SVR24 results of telaprevir therapy in HCV/HIV-coinfected patients
• Final SVR24 results of boceprevir therapy in HCV/HIV-coinfected patients

• 96-week viral response rates for entecavir and tenofovir combination therapy
• Tenofovir 5-year data
• Prolonged pegylated interferon data
• Other factors affecting response to therapy in HBeAg+ patients
• Predictors of response to pegylated interferon therapy
• New figure (Figure 5) and revised Table 11
• Need for screening in patients with cirrhosis on HBV suppressive therapy
• Journal Highlight: Long-term treatment with tenofovir associated with histologic improvement in 87% and fibrosis regression in 51% of patients.

• Updated to include new information on chronic hepatitis E virus infection in heart transplantation recipients
• References reviewed and updated to reflect recent publications

• References reviewed and updated to reflect recent publications

• References reviewed and updated to reflect recent publications 

•  Video Insight: Updated to include a video commentary in which Anna S. F. Lok, MD, discusses the importance of preventing reactivation of hepatitis B and approaches for its management.

• Video Insight: Updated to include a video commentary in which Anna S. F. Lok, MD, discusses the importance of preventing reactivation of hepatitis B and approaches for its management.

• Video Insight: Updated to include a video commentary from John W. Ward, MD, discussing the new guidance from the CDC on one-time HCV screening for all US residents born between 1945 and 1965.

• Updated to include new guidance from the US Centers for Disease Control and Prevention for one-time HCV screening of all persons within the United States born between 1945 and 1965

Updated to reflect the 2012 EASL HBV guidelines, including:

• More specific recommendations on choice of anti-HBV agents for use in pregnancy
• Updated recommendations for patients receiving pre-emptive therapy before immunosuppressive therapy or chemotherapy

• Amended recommendations for liver biopsy and treatment 
• Updated recommendations on management of nucleos(t)ide analogue resistance
• Updated recommendations on the frequency of HBV DNA testing for patients receiving entecavir or tenofovir
• Stopping rules for patients receiving peginterferon alfa therapy
• New recommendations for patients receiving entecavir or tenofovir who present with a partial virologic response

• Updated to include new drug-drug interaction data on ritonavir-boosted HIV protease inhibitors when coadministered with boceprevir.

• Updated to include new data on the pharmacokinetics of boceprevir coadministration with cyclosporine or tacrolimus

• Now available: Joshua Levitsky, MD, MS, and Lisa B. VanWagner, MD, MS, outline the epidemiology, clinical presentation, diagnosis, and clinical management of the secondary and exotic hepatotropic viruses in patients with solid organ transplantations.

• In this CME-certified chapter, Mark S. Sulkowski, MD, reviews the latest data and available treatment guidelines on the optimal management of hepatitis C in special populations, including patients with renal disease, patients with HIV coinfection, children, and liver transplant recipients.

• Now available: Francesco Negro, MD, provides an in-depth review of past and current HCV transmission trends, the latest understanding of HCV pathogenesis, key assays and recommendations for the diagnosis of HCV, and the natural history of both acute and chronic HCV infection. 

• Now available: Mario Rizzetto, MD, reviews the biology, epidemiology, pathogenesis, natural history, clinical presentation, and current treatment recommendations for hepatitis delta infection. 

• Now available: Tram T. Tran, MD, provides guidance on how management should be individualized in special populations of HBV-infected patients. 

• Now available: Harry L. A. Janssen, MD, PhD, and Milan J. Sonneveld, MSc, provide detailed guidance on the appropriate candidates for hepatitis B treatment, preferred treatment options and strategies, how to manage antiviral resistance, and the appropriate choice of therapy for patients with advanced liver disease.  

• Now available: Marc G. Ghany, MD, provides an in-depth overview of hepatitis B prevalence trends, transmission patterns, natural history, and pathogenesis as well as a review of approaches to the diagnostic assessment of hepatitis B infection. 

• Now available: Kenneth E. Sherman, MD, PhD, reviews the similarities and differences between hepatitis A and E viruses as he discusses epidemiology, clinical presentation, treatment, and prevention.  

• Now available: Raymond T. Chung, MD, and Esperance Anne Kreek Schaefer, MD, MPH, provide an overview of the epidemiology, natural history, life cycle, pathogenesis, and therapeutic targets of the 5 major hepatitis viruses.