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Clearing the Confusion:
Lab Testing in the Diagnosis and Management of Viral Hepatitis
1
Clearing the Confusion:
Lab Testing in the Diagnosis and
Management of Viral Hepatitis
April 12, 2011
Your Host: Karen Riba
• Handout is available by clicking on the handout
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• Questions will be answered at the end of the
presentation
Welcome
Your Host: Karen Riba
• P.A.C.E. credit may be obtained by submitting
your completed evaluation form at the end of the
webinar
• CE credit may be obtained by downloading the
“Certificate of Completion”
• PAML employees will be able to receive one hour
of continuing education.
Welcome
Dr. Katherine Soreng, Ph.D.
Dr. Soreng received her BSc. in Biology
from the University of Washington in
Seattle. She was awarded a Ph.D. in
Immunology and Molecular
Pathogenesis from Emory University in
Atlanta, GA, publishing a thesis on
protein synthesis and cytoskeletal
elements in the Class II restricted
processing of antigen.
Speaker Information
Speaker Image
At the end of this presentation participants will be
able to:
• Identify the appropriate tests involved in the
differential diagnosis of viral hepatitis (including
acute vs chronic)
• Discuss the algorithms useful for both hepatitis B
and C antibody test confirmation
• Discuss the clinical utility of viral load and
genotype in both hepatitis B and C infection.
Learning Objectives Disclosures
Full-time employee of Siemens
Healthcare
Sr. Manager of Clinical Education
and Scientific Publications
Clearing the Confusion:
Lab Testing in the Diagnosis and Management of Viral Hepatitis
2
Stages of Liver Damage
NormalLiver injury/
inflammation
Liver
fibrosisCirrhosis
Liver
failure/
liver
cancer
© Siemens AG, 2009. All rights reserved
Physical Symptoms Of Liver Failure
Early Late
Nausea
Loss of appetite
Fatigue
Diarrhea
Clay stool, dark urine, tenderness
Jaundice
Bleeding/bruising easily
Swollen abdomen/legs
Intense skin itching
Mental disorientation
YEARS
© Siemens AG, 2009. All rights reserved
Common Causes of Hepatitis
Metabolic
DiseaseBacteria
Viruses
Alcohol
Drugs
© Siemens AG, 2009. All rights reserved
Introduction
“The beginning of health is to know the disease” Chinese proverb
h
Fever Jaundice
Acute Hepatitis Symptoms
Mouth & Upper GI Tract
Arm & Leg Joints & Muscles
Lower Digestive Tract
h© Siemens AG, 2009. All rights reserved
Common Tests for Identifying Liver Disease
Is there
liver injury?
What is causing
the damage?
ALT
AST
Alkaline phosphatase
LDH
Total bilirubin
Fatty
Liver
Alcohol
Viral
hepatitis
© Siemens AG, 2009. All rights reserved
Clearing the Confusion:
Lab Testing in the Diagnosis and Management of Viral Hepatitis
3
Common Types of Viral Hepatitis
Hepatitis A
Hepatitis E
Hepatitis CHepatitis D
Hepatitis B
© Siemens AG, 2009. All rights reserved
Viral Hepatitis - Overview
Type of Hepatitis
A B C D E
Genome RNA DNA RNA RNA RNA
Source of virus
feces blood/blood-derived
body fluids
blood/blood-derived
body fluids
blood/blood-derived
body fluids
feces
Route of transmission
fecal-oral percutaneous
permucosal
percutaneous
permucosal
percutaneous
permucosal
fecal-oral
Chronic infection
no yes yes yes no
Prevention pre/post-exposure immunization
pre/post-exposureimmunization
blood donor
screening;
risk behavior modification
pre/post-exposure immunization; risk behaviormodification
ensure safe
drinking
water
© Siemens AG, 2009. All rights reserved
Acute vs. Chronic Viral Hepatitis
Death
RecoveryTime
Liver damage
6 months
Acute
Chronic
Acute
Fulminant
HAV
HEV
Progression
Stable diseaseHBV
HDV
HCV
h© Siemens AG, 2009. All rights reserved
Hepatitis A
© Siemens AG, 2009. All rights reservedh
HAV: Severity
Usually mild, most recover
Frequently symptomless, especially in children
May be sick for several months
Can cause acute liver failure and death
Patient populations with the greatest risk for
significant disease include:
Persons 50 years of age or older
Persons with other liver diseases, such
as hepatitis B or C.
h© Siemens AG, 2009. All rights reserved
HAV Serological Course
0 1 2 3 4 5 6 12 24
Titer
Months after exposure
anti-HAV IgM
Total anti-HAV
ALT
Symptoms
Fecal HAV
shedding
Resolution and immunity
HAV Infection
© Siemens AG, 2009. All rights reserved
Clearing the Confusion:
Lab Testing in the Diagnosis and Management of Viral Hepatitis
4
HAV Serological Tests
Anti-HAV IgM
Indicates acute
infection
Can be detected in
blood about 3-4 weeks
after infection
IgM antibodies not
generally detectable
within 3-12 months
Anti-HAV-Total
Detects both IgM and
IgG
Positive in acute and
recovered hepatitis
Present in infected and
vaccinated populations
Hepatitis B
© Siemens AG, 2009. All rights reservedh
Andrew Magill, Creative Commons Attribution 2.0 License
HBV infected
maternal
blood
HBV Transmission Risk Factors
Birth (spread from an infected
mother to her baby during birth)
Sex with an infected partner
Sharing needles, syringes, or other
drug-injection equipment
Sharing items such as razors or
toothbrushes with an infected person
Direct contact with the blood or open
sores of an infected person
Exposure to blood from needlesticks
or other sharp instruments © Siemens AG, 2009. All rights reserved
HBV Infection Outcomes in Adults
Acute HBV
Subclinical
infection
HBsAg carrier
~5%
Chronic hepatitis
Liver injury
Fulminant
hepatitis
Liver cancer Death
Clinical
infection
Recovery
immunity ~95%
Asymptomatic
HBsAg carrier
Liver cirrhosis
h© Siemens AG, 2009. All rights reserved
HBV Transmission
High Viral Titer
Moderate Viral Titer
Low Viral Titer
Urine Feces Sweat TearsBreast
milk
SemenVaginal
fluidSaliva
Blood SerumWound
exudates
Vertical
transmission
© Siemens AG, 2009. All rights reserved
HBV Infection Outcomes in Newborns
Acute HBV
Subclinical
infection
HBsAg carrier
~5%
Chronic hepatitis
Liver injury
Fulminant
hepatitis
Liver cancer Death
Clinical
infection
Recovery
immunity ~95%
Asymptomatic
HBsAg carrier
Liver cirrhosis
HBsAg carrier
~90%
HBsAg carrier
~10%
© Siemens AG, 2009. All rights reserved
Clearing the Confusion:
Lab Testing in the Diagnosis and Management of Viral Hepatitis
5
Chronic HBV Correlates Inversely with Age
Age at
InfectionChronicity (%)
<6 months 90-95
>6 months 80
1-4 years 30-50
>4 years 5-10
h© Siemens AG, 2009. All rights reserved
Immunoprophylaxis to Prevent Perinatal Transmission
Recommended Immunization Schedule for Persons Aged 0 Through 6 Years—United States 2009
http://www.cdc.gov/vaccines/recs/schedules/downloads/child/2009/09_0-6yrs_schedule_pr.pdf
Vaccine Dose and HBIG* Age
Infant Born to Mother Known to be HBsAg Positive
First Vaccine Dose Birth (within 12 hours)
HBIG Birth (within 12 hours)
Second Vaccine Dose 1 – 2 months
Third Vaccine Dose 6 months
Infant Born to Mother Not Screened for HBsAg
First Vaccine Dose Birth (within 12 hours)
HBIG
Screen mother ASAP. If HBsAg
positive, give ASAP but by no
later than 1 week of age
Second Vaccine Dose 1 – 2 months
Third Vaccine Dose 6 months*Hepatitis B Immune Globulin
© Siemens AG, 2009. All rights reserved
Hepatitis B Virus Structure
Nucleocapsid
(core antigen)
Envelope
Viral DNA
HBe AntigenSurface antigens
h© Siemens AG, 2009. All rights reserved
Hepatitis B Testing
Serology
Manual and automated methods are available to identify antibody to or antigen from the Hepatitis B virus
Molecular Tests
Detect viral load for therapeutic decision making
© Siemens AG, 2009. All rights reserved
Serological Tests For HBV
Anti-HBc
IgM
Anti-HBc
total
HBsAg
Anti-HBs
Anti-HBe
HBeAgAntigen
detection
Antibody
detection
© Siemens AG, 2009. All rights reserved
HBV Serological Profile:Acute Infection with Recovery
Weeks after exposure
HBsAg
HBeAg Anti-HBe
Symptoms
anti-HBc IgM Total anti-HBc
Titer
0 4 8 12 16 20 24 28 32 36 52 100
anti-HBs
h© Siemens AG, 2009. All rights reserved
Clearing the Confusion:
Lab Testing in the Diagnosis and Management of Viral Hepatitis
6
HBV Serological Profile:Chronic “Non-replicative” Infection
Weeks after exposure
HBsAg
HBeAg Anti-HBe
anti-HBc IgM
anti-HBs rarely seen
Titer
0 4 8 12 16 20 24 28 32 36 52 100
Chronic non-
replicative state
Chronic
replicative state
Chronic
6 month = chronic
Total anti-HBc
h© Siemens AG, 2009. All rights reserved
Weeks after exposure
HBsAg
HBeAg
anti-HBc IgM
anti-HBs rarely seen
Titer
0 4 8 12 16 20 24 28 32 36 52 100
Chronic (Years)Acute (6 months)
Total anti-HBc
HBV Serological Profile:Chronic Replicative Infection
h© Siemens AG, 2009. All rights reserved
Hepatitis B Testing
Test Result
Probable Diagnosis HBsAg aHBcT aHBc IgM HBeAg aHBe aHBs
Uninfected, unvaccinated – – – – – –
Vaccinated (immune) – – – – – +
Acute infection + + + + – –
Active infection: recovering – + – – + –
Recovered (immune) – + – – + +
Chronic replicative infection + + – + – –
Chronic nonreplicative infection + + – – + –
© Siemens AG, 2009. All rights reserved
Treating Chronic HBV
Interferon
Alpha
Pegylated
interferon
Lamivudine
Tenofovir
Entecavir
Adefovir
Telbivudine
Treatment
options
include
Treatment
is often lifelong -
few are cured
h© Siemens AG, 2009. All rights reserved
Treatment Goals for Chronic HBV
Weeks after exposure
HBsAg
HBeAg Anti-HBe
IgM anti-HBc
anti-HBs rarely seen
Titer
0 4 8 12 16 20 24 28 32 36 52 100
Chronic non-
replicative state
Chronic
replicative state
Chronic
6 month = chronic
Total anti-HBc
h© Siemens AG, 2009. All rights reserved
Guidelines for treatment
© Siemens AG, 2009. All rights reservedh
Clearing the Confusion:
Lab Testing in the Diagnosis and Management of Viral Hepatitis
7
Hepatitis C
© Siemens AG, 2009. All rights reservedh
HCV Prevalence
> 2.9%
2.0 – 2.9%
1.0 – 1.9%
< 1.0%
No data
US 3 – 4M
Americas 12 – 15M
Western Europe
5MEastern Europe
10M
Africa 30 – 40M
Southeast Asia
30 – 45M
Far East Asia 60M
Australia 0.2M
10,000 – 12,000 deaths per year, US
Leading cause of liver transplants, US
No vaccinewwwnc.cdc.gov/.../yellowbook/2008/ch4/hepa.aspx
© Siemens AG, 2009. All rights reserved
6 HCV Genotypes and > 50 Subtypes
1(I)
1c(0)1(II) 1a
3c
1b
3e 3d
1c(E)
3(III)3(VI)
3a
TD3
10a
3f3b
h
9a
i
9b
j 9c
k 8b
8a
l
mNGIn
g
11ae7ac
7d
7bd
fb
a
a
d
e
f
6a4e
4g
4h4f
4d
5a
6b 7c/NGII/VII
4a(E)
4a(B)
4c
c b
2(I)
1
2
54
3
6
*
US &
Western
Europe
Japan &
Taiwan
Australia &
South Asia
Hong Kong
& Southeast
Asia
Middle
East South
Africa
© Siemens AG, 2009. All rights reserved
HCV Infection In The US
HCV HIV
# Cases
(millions)
4
3
2
1
Source: Clin Gastroenterol Hepatol. 2006 October; 4(10): 1278–1282.
Infected for life
Up to 2% of US population infected
Estimated 35,000 new HCV cases
per year in the US
80 %
© Siemens AG, 2009. All rights reserved
HCV: “The Silent Epidemic”
Symptoms rare (~20%) and generalizedEarly Stage
Symptoms still rare (nausea, jaundice, fatigue)Late Stage
Often 20-30 years post-exposureLiver Disease
Presentation
Elevated liver enzyme profiles (AST, ALT)Initial ID of
Damage
Infected individuals may unknowingly spread virusTransmission
Chronicity >75%-80%Disease
© Siemens AG, 2009. All rights reserved
HCV Transmission
* Reduced after implementation of routine blood screening
Illegal drug abuse
60%
Sexual
21%
No Identified risks
10%
Transfusions*
3%
Occupational
3%
Household
3%
© Siemens AG, 2009. All rights reserved
Clearing the Confusion:
Lab Testing in the Diagnosis and Management of Viral Hepatitis
8
Although IV Drug Abuse Is The Leading Risk, Other Causes Of HCV Include:
Tattoos
Occupational
hazards
Manicure and pedicure
© Siemens AG, 2009. All rights reserved
Another Risk - Going to a Clinic?!
Source: CDC press release Jan. 6, 2009
60,000
patients
At risk ofHBV, HCV, HIVafter failure of
medical personnel tofollow proper
practice
Hepatitis C Virus (HCV)
Envelope Core
Envelope
glycoproteins
Viral RNA
(9400 nucleotides)
h© Siemens AG, 2009. All rights reserved
HCV RNA Genome
C E1 E2 NS5A NS5B
2nd or 3rd generation HCV IA detects antibody to 3 or more viral proteins
5’NTR Structural Proteins Non-structural Proteins 3’NTR
Nucleocapsid
p22
Metalloprotease
Serine Protease
RNA Helicase
p70
NS1 NS2 NS3NS4A NS4B
p8 p27
Interferon
Resistance
Protein
P56/58
RNA
Polymerase
p68
Cofactors
First Generation Second Generation Third Generation
© Siemens AG, 2009. All rights reserved
IgG
Control
Level II
c100(p)
5-1-1(p) c33c c22 (p) NS5 hSOD
IgG
Control
Level I
Positive
Indeterminate
Negative
Negative
Positive
Indeterminate
Interpretation
RIBA for HCV antibody confirmation
© Siemens AG, 2009. All rights reserved
HCV Infection Testing Algorithm
RIBA for Anti-HCV
Medical
EvaluationReport
Negative PCR
Normal ALT
Positive PCR
Elevated ALT
HCV RNA
Testing
Negative
ReportNegative Positive
Positive OR
Negative PositiveIndeterminatePositive
(but < Index or S/CO)
ReportValidated
Additional
Laboratory
Evaluation
(PCR, ALT)
≥
Index or S/CO
© Siemens AG, 2009. All rights reserved
Clearing the Confusion:
Lab Testing in the Diagnosis and Management of Viral Hepatitis
9
Normal
HCV Progression
Titer
0 1 2 3 4 5 6 1 2 3 4Months YearsTime after exposure
Symptoms ±
HCV RNA
Anti-HCV
ALT
© Siemens AG, 2009. All rights reserved
Titer
0 1 2 3 4 5 6 1 2 3 4Months Years
Time after exposure
Normal
Symptoms ±
HCV RNA
Anti-HCV
ALT
HCV Progression
AbHCV/
RIBA
ALT/AST
Other
tests
Genotype
and Viral
Load
Liver
Biopsy
© Siemens AG, 2009. All rights reserved
Anti-HCV serology
Viral Load
Genotyping Assay
Viral Load/Qualitative assay
Viral Load/Qualitative assay
Testing of the HCV Infected Patient
Has the patient ever been
infected?
How much virus is present?
What genotype is the patient
infected with?
Is the patient responding to
therapy?
Is the patient relapsing?
© Siemens AG, 2009. All rights reserved
TMA*Add primers & enzymes
Copies(RNA)
One detection probe per copy
HCV RNA
HCV Virus
Add target probes and amplification probes
bDNA
Multiple detection probes per target
Technologies to detect HCV RNA include:
RT-PCRAdd primers & enzymes
Copies (DNA)
One detection probe per amplified copy
TMA = Transcription Mediated Amplification
HighSensitivityQualitative
Assay
TargetAmplificationQuantitative
Assay
SignalAmplificationQuantitative
Assay
© Siemens AG, 2009. All rights reserved
Technologies to detect HCV genotype include:
• RT-PCR with sequencing
• Line Probe Assay (LiPA)
Genotype 1a, 1b
Genotype 2, 3
© Siemens AG, 2009. All rights reserved
Molecular Testing in Treatment of HCV Patients
Pegylated
interferonRibavirin
Sensitive qualitative, quantitative viral load,
and genotyping central to therapy
Current HCV therapyTherapy response varies with genotype and compliance
© Siemens AG, 2009. All rights reserved
Clearing the Confusion:
Lab Testing in the Diagnosis and Management of Viral Hepatitis
10
Treatment of HCV
Strader, et al. 2004; Hepatology, Vol. 39. No. 4 page 1147
Ghany, et al. 2009, Hepatology, Vol. 49; No. 4, page 1335
© Siemens AG, 2009. All rights reserved
NIH Guidelines
© Siemens AG, 2009. All rights reservedh
Side Effects of HCV Therapy
Grossman H et al.. 41st Interscience Conference on Antimicrobial Agents and
Chemotherapy. December 16-19, 2001. Chicago. Abstract I-254.
Pegylated interferon Ribavirin
Neuropsychiatric
Depression, anxiety, irritability, fatigueCough and dyspnea
Bone marrow depression
Neutropenia, thrombocytopeniaHemolytic anemia
Anorexia / weight loss Teratogenicity
Alopecia Insomnia
Exacerbation of autoimmune
disordersRash / Puritus
Thyroid dysfunction
Hashimoto’s thyroiditisNausea
© Siemens AG, 2009. All rights reserved
HCV Treatment Nomenclature
“SVR”: Sustained Virologic Response
“EVR”: Early Virologic Response
“RVR”: Rapid Virologic Response
Stopping Rules
h© Siemens AG, 2009. All rights reserved
Management of Hepatitis C: 2002NIH Consensus Conference Statement
• Early viral response (EVR):
• A minimum 2 log decrease in viral load during the first 12 weeks of treatment
• Predictive of SVR and should be a routine part of monitoring patients
12 weeks
treatment
© Siemens AG, 2009. All rights reserved
2002 NIH Consensus Conference
Baseline: Quantitative & Genotype
Week 12: Quantitative
<2 log10 drop
Consider
therapy end
End treatment: Qualitative
6 month follow-up: Qualitative
HCV RNA (+)
Non-responder
≥2 log10 drop
Genotype 1
48 weeks
Genotype non-1
24 weeks
HCV RNA (+)
Relapser
HCV RNA (-)
Sustained responder
HCV Therapy Algorithm
© Siemens AG, 2009. All rights reserved
Clearing the Confusion:
Lab Testing in the Diagnosis and Management of Viral Hepatitis
11
SVR vs. Non-Response (NR) to the Anti-Viral Therapies*
80/80/80 = >80% dose of peg-interferon;
>80% dose of ribavirin;
>80% of prescribed treatment duration* McHutchison JG et al. The effects of interferon alpha-2b in
combination with ribavirin on health related quality of life and work productivity. J Hepatol. 2001;34:140-147. McHutchison JG et al.
Adherence to combination therapy enhances sustained response in
Genotype-1-infected patients with chronic hepatitis C. J Gastroenterology. 2002; 123:1061-1069
63%
54%
41%
15%
37%
46%
59%
85%
0% 20% 40% 60% 80% 100%
Peg + RBV
(80/80/80)
Peg + RBV
IFN + RBV
IFN mono
SVR
NR
© Siemens AG, 2009. All rights reserved
Predictive SVR
Therapy Response
Viral load
Therapy course (weeks)
0 2 4 6 8 10 12
Initial
load
2 log
drop
EVRNon-responder
2002 NIH Consensus Conference
Therapy Cessation at
12 Weeks?
© Siemens AG, 2009. All rights reserved
n = 63
(14%)
n = 390
(86%)
2 log10 drop
or Neg HCV RNA
Week 12 (N = 453)
Outcome with PEG-IFN 2a +R:12 Week Stopping Rule
Yes
No
SVR
NR
SVR
NR
PPV
NPV
n = 253
(65%)
n = 61
(97%)
n = 137
(35%)
n = 2
(3%)
Fried et al. 2002. NEJM 347(13):975-982
© Siemens AG, 2009. All rights reserved
n = 98
(21%)
n = 380
(79%)
2 log10 drop
or Neg HCV RNA
Week 12 (N = 478)
Outcome with PEG-IFN 2b +R:12 Week Stopping Rule
Davis et al. Hepatology (2003) 38(3):645-652
Yes
No
SVR
No SVR
SVR
No SVR
PPV
NPV
n = 273
(72%)
n = 98
(100%)
n = 107
(28%)
n = 0
(0%)
© Siemens AG, 2009. All rights reserved
Therapeutic Response: RVR
Predictive SVR
Initial
load
2 log
drop
EVRNon-responder
RVR
Vir
al L
oad
Therapy course (weeks)
0 2 4 6 8 10 12
Rapid Viral Response
© Siemens AG, 2009. All rights reserved
RVR in the 2009 AASLD HCVTreatment Update
Ghany, et al. 2009, Hepatology, Vol. 49; No. 4, page 1335
© Siemens AG, 2009. All rights reserved
Clearing the Confusion:
Lab Testing in the Diagnosis and Management of Viral Hepatitis
12
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Time to Undectability Predicts SVR
Ferenci, P, et al. J Hepatol 2005;43:425-433
Week 4 Negative≥ 2 log
< 2 log
≥ 2 log
< 2 log
Week 12 Negative Negative Negative≥ 2 log
≥ 2 log
Week
24Negative Negative Negative Negative Negative
91% 72% 66% 48% 43%
2002 Guidelines
Pat
ien
ts w
ith
SV
R (%
)
© Siemens AG, 2009. All rights reserved
Using RVR in patient management
2002 NIH Consensus Conference
Baseline: Quantitative & genotype
Week 12: Quantitative and/or qualitative
<2 log10 drop
Consider
therapy end
End treatment: Qualitative
6 month follow-up: Qualitative
HCV RNA (+)
Non-responder
≥2 log10 drop
Genotype 1
48 weeks
Genotype non-1
24 weeks
HCV RNA (+)
Relapser
HCV RNA (-)
Sustained responder
HCV?Week 4: Quantitative or Qualitative
© Siemens AG, 2009. All rights reserved
6 HCV Genotypes and > 50 Subtypes
1(I)
1c(0)1(II) 1a
3c
1b
3e 3d
1c(E)
3(III)3(VI)
3a
TD3
10a
3f3b
h
9a
i
9b
j 9c
k 8b
8a
l
mNGIn
g
11ae7ac
7d
7bd
fb
a
a
d
e
f
6a4e
4g
4h4f
4d
5a
6b 7c/NGII/VII
4a(E)
4a(B)
4c
c b
2(I)
1
2
54
3
6
*
US &
Western
Europe
Japan &
Taiwan
Australia &
South Asia
Hong Kong
& Southeast
Asia
Middle
East South
Africa
HCV genotype assessment guides therapy
and predicts likelihood of SVR
© Siemens AG, 2009. All rights reserved
HCV Genotypes can Predict Treatment Success
Treatment Success
Treatment Success
Genotype 1
40% Effective
Genotype Non-1
80% Effective
Pegylated
InterferonRibavirin
© Siemens AG, 2009. All rights reserved
HCV Treatment: Genotypes Make a Difference
Adapted from Ann Intern Med 2004; 140: 346-355 & Lancet
2001; 358: 956-965
Adapted from Hepatology. 2002;36:(5 suppl 1):S3-S20
Treatment Response (SVR) with Pegylated Interferon and Ribavirin
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
All Patients Genotype 1 Genotype 2&30%
10%
20%
30%
40%
50%
60%
70%
80%
90%
All Patients Genotype 1 Genotype 2&3
© Siemens AG, 2009. All rights reserved © Siemens AG, 2009. All rights reserved
Clearing the Confusion:
Lab Testing in the Diagnosis and Management of Viral Hepatitis
13
HCV Mono-infected vs HCV-HIV Co-infected Patients
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
Pa
tie
nts
wit
h S
VR
(%
)
All Patients Genotype 1 Genotype 2 & 3
HCV Only
HCV + HIV
63% 40% 52% 29% 85% 62%
Treatment with Pegylated Interferon + Ribavirin
© Siemens AG, 2009. All rights reserved
Patient Presentation
Nausea, slight fever, hepatomegaly, jaundice
h© Siemens AG, 2009. All rights reserved
Acute Viral Hepatitis Testing Panel
HAV IgM HBsAg HBV Core
IgM
Interpretation
Pos Neg Neg Acute HAV
Neg Neg Neg
HCV-acute, chronic,
resolved?
Neg Pos NegChronic
HBV?
Anti-HCV
Neg
Pos
Neg
Neg Pos Pos Acute HBV?Neg
© Siemens AG, 2009. All rights reserved
Resources
• Ann Robinson, Ph.D., DABMM, FAAM Director, Microbiology and Virology [email protected]
• Virginia Henderson, M,SV (ASCP)
Technical Supervisor, Virology
• American Association for the Study of Liver Disease (AASLD) – www.aasld.org
• Diagnosis, Management and Treatment of Hepatitis C: An Update – www.aasld.org
• P.A.C.E. credit may be obtained by submitting
your completed evaluation form. You will find the
form by clicking on the “handouts” icon in the
upper right hand corner of your screen
• CE credit may be obtained by downloading the
“Certificate of Completion” under the “handouts”
icon
• PAML employees will be able to receive one
hour of continuing education credit by submitting
your attendance through CE Manager.
Thank-you for Attending
This webinar has been recorded and will be
available by April 14th, on www.paml.com,
under the Hospital Tab/Hospital
Portal/Webinar Series heading
Thank-you for Attending