Latest Updates

• 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

• Updated AASLD/IDSA HCV management guidance includes recommendations on use of newly approved HCV regimens

• FDA and EMA approve glecaprevir/pibrentasvir for 8-week treatment of all HCV genotypes
• FDA approves sofosbuvir/velpatasvir/voxilaprevir for 12-week retreatment of all HCV genotypes following failure of an NS5A inhibitor–containing regimen

• 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

• Updated AASLD/IDSA guidance on initial HCV treatment now recommends 8-week ledipasvir/sofosbuvir for treatment-naive nonblack patients with genotype 1 HCV infection, no cirrhosis, no HIV coinfection, and baseline HCV RNA < 6 million IU/mL
• Revised AASLD/IDSA guidance on retreatment of genotype 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 EASL guidance on HCV treatment

• FDA approves sofosbuvir/velpatasvir for the treatment of all HCV genotypes
• Updated AASLD/IDSA guidance on initial HCV treatment
• Revised AASLD/IDSA guidance on HCV retreatment
• FDA approves once-daily, extended release coformulation dasabuvir/ombitasvir/paritaprevir/ritonavir for the treatment of genotype 1 HCV infection 

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

• FDA approves elbasvir/grazoprevir for the treatment of chronic genotype 1 or 4 HCV infection
• FDA and EMA expand indications for daclatasvir to include use in patients with advanced liver disease and those with HIV coinfection
• FDA expands indications for ledipasvir/sofosbuvir to include use in patients with advanced liver disease
• Updated AASLD/IDSA guidance on initial HCV treatment
• Revised AASLD/IDSA guidance on HCV retreatment
• FDA revised indications for ombitasvir/paritaprevir/ritonavir plus dasabuvir for patients with genotype 1b HCV 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 

• Ombitasvir/paritaprevir/ritonavir-containing regimens contraindicated for patients with moderate to severe liver disease
• Ledipasvir/sofosbuvir approved by FDA for treating genotypes 4, 5, and 6 HCV infections
• Updated AASLD/IDSA guidance on HCV treatment candidacy
• New data from real-world use of ledipasvir/sofosbuvir
• Data from phase III RUBY-I trial of ombitasvir/paritaprevir/ritonavir plus dasabuvir for genotype 1 HCV in patients with chronic kidney disease
• Data from phase III ALLY-3+ trial of daclatasvir plus sofosbuvir and ribavirin for genotype 3

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

• FDA expands indication for simeprevir to include use in genotype 4 HCV infection

• 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

• Latest guidance provided by AASLD/IDSA on the management of HCV infection includes new recommendations for treatment in patients with failure on previous regimens
• Updated to reflect FDA approval of daclatasvir for the treatment of genotype 3 HCV infection
• Updated to reflect FDA approval of ombitasvir/paritaprevir/ritonavir for the treatment of genotype 4 HCV infection

• 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

• New discussion on types of therapies by drug class for HCV infection
• Latest guidance provided by AASLD/IDSA on the management of HCV infection including integration of recently approved DAAs
• Updated clinical data on efficacy, drug resistance, drug–drug interactions, and adverse events of ombitasvir/paritaprevir/ritonavir plus dasabuvir for the treatment of genotype 1 HCV infection 
• Updated to reflect most recent guidance from the EASL on the treatment of HCV

• 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

• New guidance provided by AASLD/IDSA on the management of acute HCV infection
• FDA approves ledipasvir/sofosbuvir for the treatment of genotype 1 HCV infection
• FDA expands indication for simeprevir to include use in combination with sofosbuvir for the treatment of genotype 1 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

• New guidance provided by AASLD/IDSA on when to initiate HCV treatment and which populations should be prioritized for urgent therapy when resources are limited 
• Updated AASLD/IDSA recommendations on assessment of liver fibrosis in patients with HCV 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 approval of daclatasvir by the European Commission

• 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

• European Medicines Agency approves simeprevir for use in treatment-naive and treatment-experienced patients infected with genotype 1 or 4 HCV

• 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 April 2014 guidelines from the European Association for the Study of the Liver incorporate sofosbuvir, simeprevir, and daclatasvir into recommended HCV treatment regimens

• 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

• Major chapter update to include comprehensive information on the latest American Association for the Study of Liver Diseases/Infectious Diseases Society of America guidelines as well as the most recent European Association for the Study of the Liver guidelines on optimal management of patients with HCV infection in settings where sofosbuvir and simeprevir are available as well as in settings where these newer agents are not yet a part of the treatment armamentarium
• This update also includes new data from studies evaluating multiple facets of HCV infection, including acute HCV infection management, types of HCV therapy, pretreatment evaluation of patients with HCV infection, efficacy of different types of HCV therapy, mechanisms, management, and prevention of antiviral drug resistance during HCV therapy, management of drug–drug interactions during HCV treatment, pretreatment and on-treatment predictors of response to HCV therapy, adverse effects of HCV therapy and recommended management approaches, and posttreatment management of patients treated for HCV infection

• 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

• Summary of the American Association for the Study of Liver Diseases and Infectious Diseases Society of America 2014 guideline recommendations on treatment of chronic hepatitis C
• Summary of the European Association for the Study of the Liver 2013 guideline recommendations on treatment of chronic hepatitis C
• EMEA approval of sofosbuvir for patients infected with chronic genotype 1-6 HCV

• 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.

• Updated briefly to acknowledge US FDA approval of simeprevir and sofosbuvir for treatment of HCV 

• Updated to reflect US FDA approval of twice-daily dosing of telaprevir 

• 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

• Video Insight: Updated to include a video commentary in which Eric Lawitz, MD, CPI, summarizes key data from the phase III trials of sofosbuvir, simeprevir, and faldaprevir presented at the 2013 EASL and DDW meetings

• 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.

• Updated to reflect the approval of eltrombopag to treat thrombocytopenia in order to allow initiation or maintenance of peginterferon-based HCV therapy
• Updated to include discussion of the use of transient elastography, newly approved by the FDA, in the evaluation of liver disease severity
• Added discussion of twice-daily dosing of telaprevir, which has been approved for use by the European Commission

• 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

• Journal Highlight: Improved SVR12 rates with sofosbuvir/ribavirin in genotype 2/3 HCV–infected patients ineligible for or intolerant of interferon-based regimens in the POSITRON and FUSION studies.

• 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.

• Journal Highlight: SVR associated with reductions in all-cause mortality as well as liver-related mortality or liver transplantation, hepatocellular carcinoma, and liver failure.

• 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 in which Marc Bourlière, MD, and Nezam H. Afdhal, MD, FRCPI, discuss new findings from the CUPIC study and the impact of these findings on patient care
• New data from the CUPIC study, including predictors of severe complications and the need for transfusion
• New data on management of anemia during protease inhibitor–based therapy

• 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.

• A new section on which patients with chronic hepatitis C should be treated with currently available regimens and which patients may benefit from waiting for newer therapies 
• Updated data on the use of boceprevir in patients with previous null response to peginterferon/ribavirin
• Updated findings and a new section the use of boceprevir- or telaprevir-based triple therapy in patients with cirrhosis
• New data on the value of detectable but unquantifiable HCV RNA vs undetectable HCV RNA at key on-treatment time points for response-guided therapy with protease inhibitor–based triple therapy
• Updated guidance on drug–drug interactions with boceprevir and telaprevir
• New data regarding the impact of baseline insulin resistance on response to telaprevir-based triple therapy
• Updated findings on the value of futility rules during telaprevir-based triple therapy
• New data on the optimal management of anemia in patients receiving boceprevir- or telaprevir-based triple therapy
• Journal Highlight: New data on the use of oral silymarin for treatment of HCV among individuals who failed treatment with interferon-based therapy

• 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: In this module, Jordan J. Feld, MD, MPH, and Hemant Shah, MD, FRCPC, review optimal strategies for managing patients with hepatitis C virus infection.

• 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.