Faculty Bibliography
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Reply to: "Does currently recommended maternal antiviral prophylaxis against mother-to-child transmission of hepatitis B virus require enhancement?"
PMCID:10563044
PMID: 37822785
ISSN: 2589-5559
CID: 5604452
Enhancing interventions for prevention of mother-to-child- transmission of hepatitis B virus
Prevention of mother-to-child transmission of hepatitis B virus (HBV) infection is a cornerstone of efforts to support progress towards elimination of viral hepatitis. Current guidelines recommend maternal screening, antiviral therapy during the third trimester of high-risk pregnancies, universal and timely HBV birth dose vaccination, and post-exposure prophylaxis with hepatitis B immunoglobulin for selected neonates. However, serological and molecular diagnostic testing, treatment and HBV vaccination are not consistently deployed, particularly in many high endemicity settings, and models predict that global targets for reduction in paediatric incidence will not be met by 2030. In this article, we briefly summarise the evidence for current practice and use this as a basis to discuss areas in which prevention of mother-to-child transmission can potentially be enhanced. By reducing health inequities, enhancing pragmatic use of resources, filling data gaps, developing advocacy and education, and seeking consistent investment from multilateral agencies, significant advances can be made to further reduce vertical transmission events, with wide health, societal and economic benefits.
SCOPUS:85164398621
ISSN: 2589-5559
CID: 5548402
Practical Implementation of Universal Hepatitis B Virus Screening for Patients With Cancer
PMID: 35700421
ISSN: 2688-1535
CID: 5341442
Innovations in Hepatitis C Screening and Treatment
New therapies offer hope for a cure to millions of persons living with hepatitis C virus (HCV) infection. HCV elimination is a global goal that will be difficult to achieve using the traditional paradigms of diagnosis and care. The current standard has evolved toward universal HCV screening and treatment, to achieve elimination goals. There are several steps between HCV diagnosis and cure with major barriers along the way. Innovative models of care can address barriers to better serve hardly reached populations and scale national efforts in the United States and abroad. Herein, we highlight innovative models of HCV care that aid in our progress toward HCV elimination.
PMCID:7917266
PMID: 33681673
ISSN: 2471-254x
CID: 4807832
The case for simplifying and using absolute targets for viral hepatitis elimination goals
The 69th World Health Assembly endorsed the Global Health Sector Strategy for Viral Hepatitis, embracing a goal to eliminate hepatitis infection as a public health threat by 2030. This was followed by the World Health Organization's (WHO) global targets for the care and management of hepatitis B virus (HBV) and hepatitis C virus (HCV) infections. These announcements and targets were important in raising awareness and calling for action; however, tracking countries' progress towards these elimination goals has provided insights to the limitations of these targets. The existing targets compare a country's progress relative to its 2015 values, penalizing countries who started their programmes prior to 2015, countries with a young population, or countries with a low prevalence. We recommend that (1) WHO simplify the hepatitis elimination targets, (2) change to absolute targets and (3) allow countries to achieve these disease targets with their own service coverage initiatives that will have the maximum impact. The recommended targets are as follows: reduce HCV new chronic cases to ≤5 per 100 000, reduce HBV prevalence among 1-year-olds to ≤0.1%, reduce HBV and HCV mortality to ≤5 per 100 000, and demonstrate HBV and HCV year-to-year decrease in new HCV- and HBV-related HCC cases. The objective of our recommendations is not to lower expectations or diminish the hepatitis elimination standards, but to provide clearer targets that recognize the past and current elimination efforts by countries, help measure progress towards true elimination, and motivate other countries to follow suit.
PMID: 32979881
ISSN: 1365-2893
CID: 4679282
Hepatitis B Virus Screening and Management for Patients With Cancer Prior to Therapy: ASCO Provisional Clinical Opinion Update
PURPOSE/OBJECTIVE:This Provisional Clinical Opinion update presents a clinically pragmatic approach to hepatitis B virus (HBV) screening and management. PROVISIONAL CLINICAL OPINION/UNASSIGNED:All patients anticipating systemic anticancer therapy should be tested for HBV by 3 tests-hepatitis B surface antigen (HBsAg), hepatitis B core antibody (anti-HBc) total immunoglobulin (Ig) or IgG, and antibody to hepatitis B surface antigen-but anticancer therapy should not be delayed. Findings of chronic HBV (HBsAg-positive) or past HBV (HBsAg-negative and anti-HBc-positive) infection require HBV reactivation risk assessment.Patients with chronic HBV receiving any systemic anticancer therapy should receive antiviral prophylactic therapy through and for minimum 12 months following anticancer therapy. Hormonal therapy alone should not pose a substantial risk of HBV reactivation in patients with chronic HBV receiving hormonal therapy alone; these patients may follow noncancer HBV monitoring and treatment guidance. Coordination of care with a clinician experienced in HBV management is recommended for patients with chronic HBV to determine HBV monitoring and long-term antiviral therapy after completion of anticancer therapy.Patients with past HBV infection undergoing anticancer therapies associated with a high risk of HBV reactivation, such as anti-CD20 monoclonal antibodies or stem-cell transplantation, should receive antiviral prophylaxis during and for minimum 12 months after anticancer therapy completion, with individualized management thereafter. Careful monitoring may be an alternative if patients and providers can adhere to frequent, consistent follow-up so antiviral therapy may begin at the earliest sign of reactivation. Patients with past HBV undergoing other systemic anticancer therapies not clearly associated with a high risk of HBV reactivation should be monitored with HBsAg and alanine aminotransferase during cancer treatment; antiviral therapy should commence if HBV reactivation occurs.Additional information is available at www.asco.org/supportive-care-guidelines.
PMID: 32716741
ISSN: 1527-7755
CID: 4704322
Disparities in utilization of services for racial and ethnic minorities with hepatocellular carcinoma associated with hepatitis C
BACKGROUND:Hepatitis C affects racial minorities disproportionately and is greatest among the black population. The incidence of hepatocellular carcinoma has increased with the largest increase observed in black and Hispanic populations, but limited data remain on whether hepatitis C hepatocellular carcinoma in racial-ethnic minorities have the same utilization of services compared with the white population. METHODS:We used the database of the National Inpatient Sample to identify hepatitis C-hepatocellular carcinoma patients (N = 200,163) who underwent liver transplantation (n = 11,491), liver resection (n = 4,896), or ablation of liver lesions (n = 6,933) from 2005 to 2015. We estimated utilization over time and assessed differences in utilization and inpatient mortality across patient characteristics. RESULTS:In multivariate analysis, factors associated with utilization of services included treatment year, sex, race, insurance status, hospital type, and comorbidity burden, with black and Hispanic patients having statistically significantly decreased utilization. Factors associated with inpatient mortality included treatment year, sex, race, insurance status, hospital type, hospital region, and comorbidity burden, with black patients having a statistically significantly greater risk of inpatient mortality. CONCLUSION/CONCLUSIONS:We identified racial and socioeconomic factors which were associated with utilization of services and inpatient mortality for patients with hepatitis C hepatocellular carcinoma. Blacks were especially disadvantaged in the receipt of care. Further work to abrogate these findings is imperative to ensure equitable provision of surgical therapies.
PMID: 32414566
ISSN: 1532-7361
CID: 4443502
Hep B Moms: A cross-sectional study of mother-to-child transmission risk among pregnant Asian American women with chronic hepatitis B in New York City, 2007-2017
Mother-to-child transmission (MTCT) is responsible for the majority of chronic hepatitis B virus (HBV) infections worldwide. Despite timely HBV immunoprophylaxis of neonates, MTCT can occur in infants born to mothers with high levels of HBV viremia. We performed a retrospective cross-sectional analysis of Asian American women with chronic HBV evaluated with HBV DNA during prenatal care at two community health sites in New York City from 2007 to 2017. We described patient's demographic and clinical characteristics, categorized their HBV disease phase, and analyzed for variables associated with high MTCT risk (defined by HBV DNA level > 200,000 IU/mL) using multivariable logistic regression. A total of 1298 pregnancies among 1012 mostly China-born (97.6%) women with chronic HBV were included in the study. Of the 1241 pregnancies among women not on antiviral treatment, 22.4 % were considered high-risk for MTCT and of these, 255 (91.7%) were HBV e antigen (HBeAg)-positive and 19 (6.8%) were HBeAg-negative. HBeAg-positive status and ALT levels between 26 to 50 U/L were associated with higher likelihood for being high-risk for MTCT. Only 0.8% of pregnancies low-risk for MTCT were in the immune active phase while the majority (58.4%) were in the inactive chronic HBV phase of infection. Approximately one in five (22.4%) pregnancies among Asian American women with chronic HBV was considered high-risk for MTCT and met criteria for antiviral therapy. Full assessment of HBV pregnant women and early coordinated care is needed to deliver interventions to prevent MTCT during critical windows of time.
PMID: 31638292
ISSN: 1365-2893
CID: 4168902
Disparities in Hepatitis B Virus Infection and Immunity Among New York City Asian American Patients, 1997 to 2017
OBJECTIVES/OBJECTIVE:To measure disparities in hepatitis B virus (HBV) infection and immunity among a high-risk patient population at a community health center in New York City. METHODS:and logistic regression analysis. RESULTS:Of 25 565 adults, 13.4% were currently infected, 52.1% were ever infected, 33.4% were immune from vaccination, and 14.5% were susceptible. Significant factors associated with ever infection were age, male sex, being China-born, limited English proficiency, having Medicaid or no insurance, and family history of HBV (P < .01). CONCLUSIONS:Our study demonstrated a high burden of HBV infection among foreign-born Asian Americans seeking care at a community health center. Public Health Implications. It is important to test patients at high risk for HBV infection with all 3 tests to identify those with current infection, risk for reactivation, or need for vaccination, and to assess the effectiveness of public health interventions.
PMID: 30383421
ISSN: 1541-0048
CID: 3399942
Assessing mother-to-child transmission risk in asian american women with chronic hepatitis B receiving prenatal care at two community health sites in New York City, 2007-2017 [Meeting Abstract]
Background: Mother-to-child transmission (MTCT) is responsible for the majority of chronic hepatitis B (CHB) infections worldwide. Identification and evaluation of pregnant women with CHB are key steps to reducing MTCT. We aimed to assess demographic and clinical characteristics and MTCT risk in Asian American women with CHB receiving prenatal care at two community health center sites in New York City. Methods: We performed a retrospective cross-sectional study of all women with CHB evaluated with HBV DNA during prenatal care from 2007 to 2017. Clinical and demographic data were extracted from medical records and analyzed. We measured the percentage of pregnant women not on antiviral treatment at high-risk for MTCT, defined by highly viremic levels (HBV DNA >=200,000 IU/mL), then further analyzed by HBeAg status, alanine aminotransferase (ALT) levels, age, birth region, and other demographic variables to measure association with MTCT risk using logistic regression analysis. Results: There were a total of 978 unique pregnancies in 804 HBsAg-positive women included in this study. All 804 women were born in Asia with 786 (97.8%) born in China, and 589 (73.3%) from China's Fujian province. Of 978 unique pregnancies, the women's mean (range) age and gestational age at the time of initial HBV DNA levels were 29.2 (18-55) years and 16.9 (1.0-38.4) weeks, respectively. The distribution of initial HBV DNA and ALT level during each unique pregnancy is presented in Figure 1. Of 933 unique pregnancies of women not on HBV antiviral treatment at initial evaluation, 203 (21.8%) had a HBV DNA level >=200,000 IU/mL of which 185 (91.1%) were HBeAg-positive, 15 (7.4%) were HBeAg negative, and 3 (1.5%) were unknown. HBeAg-positive status (aOR 204.2, CI 104.0-400.8, p<0.01) and elevated ALT (aOR 1.02, CI 1.01-1.03, p<0.01) were associated with increased odds for high levels of viremia. Conclusion: At two community health sites providing perinatal HBV care to primarily Asian American patients, 21.8% of pregnant women were high risk for MTCT. While HBeAg-positive status was associated with high viremia, it is a limited predictor of MTCT alone as 7.4% of high risk patients were HBeAg-negative. Full assessment of CHB pregnant women and early coordinated care is needed to offer and deliver interventions to prevent MTCT during critical windows of time including antiviral therapy for highly viremic women. (Figure Presented)
EMBASE:624566107
ISSN: 1527-3350
CID: 3430552
