The Liver for the Nonhepatologist

The Liver for the Nonhepatologist Michael R. Charlton, MBBS Director of Hepatology and Liver Transplantation Intermountain Medical Center Salt Lake Ci...
Author: Randell Owens
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The Liver for the Nonhepatologist Michael R. Charlton, MBBS Director of Hepatology and Liver Transplantation Intermountain Medical Center Salt Lake City, Utah

Chicago, Illinois: September 16, 2016

Learning Objectives After attending this presentation, participants will be able to:  Choose optimal antiviral therapy for difficult-to-treat

patients, such as patients with end-stage renal disease and advanced liver disease.  Evaluate and manage routine aspects of medical care related to liver disease in patients with chronic hepatitis C virus (HCV) infection, including determining severity of liver disease and screening for hepatocellular carcinoma.

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Overview

• What is the natural history and prognosis of cirrhosis?

• How do you diagnose cirrhosis? • Managing common complications • Other Issues - immunization, medications, etc. in patients with cirrhosis

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Overview

• What is the natural history and prognosis of cirrhosis?

• How do you diagnose cirrhosis? • Managing common complications • Other Issues - immunization, medications, etc. in patients with cirrhosis

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Natural history and disease progression following HCV infection HCV infection Acute infection, 20–30% with symptoms Clearance of HCV RNA, 15–25%

Fulminant hepatitis, rare

Chronic infection, 75–85% Extrahepatic manifestations  Variceal hemorrhage  Ascites  Encephalopathy  Jaundice  HCC

Chronic active hepatitis Cirrhosis, ~30% over 20 years

Decompensated cirrhosis, 5-year survival rate of 50%

Clinical burden HCC 1–4% per year HCC: hepatocellular carcinoma

Chen S, et al. Int J Med Sci 2006;3:47–52

Chronic HCV Infection Reduces Life Expectancy

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25% died prematurely 64% died prematurely

Perspectives in Virology, August 2015

94% died prematurely

Pinchoff J, et al. Clin Infect Dis 2014;58:1047–54

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Extrahepatic manifestations of HCV

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• Mixed cryoglobulinemia (type II and III) Prevalence of HCV 80-90%; reverse 30-50% Glomerulonephritis- MPGN

• Porphyria cutanea tarda • Lymphoma (B cell) HCV present in 9-32%

• Type II DM OR 3.77 (1.8-7.9)

• Lichen Planus • Vitiligo • CNS Subhash C. Ann Intern Med, 1995. Zuckerman E. Ann Intern Med, 1997. Mehta SH. Ann Intern Med, 2000. Harris N. NEJM, 2002.

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HCV eradication (SVR) is associated with a reduction in All-Cause Mortality

All-cause mortality (%)

Long-term follow-up study from 5 tertiary care hospitals of HCV patients with advanced fibrosis/cirrhosis (n=530)

Without SVR

P

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