Hepatitis B Pre-Treatment Evaluation and Treatment Initiation
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HEPATITIS B CLINICAL TRAINING SERIES Hepatitis B Pre-Treatment Evaluation and Treatment Initiation Lisa Ganjhu, DO, FACG, AGAF Division of Gastroenterology and Hepatology Clinical Associate Professor of Medicine Department of Medicine NYU Langone School of Medicine
Housekeeping Notes Have a question for the presenter • Type the question into the chat box and Meg will read them aloud to the presenter at the end Claiming CE • After the training, you will receive an e-mail with instructions, the course number, and the access code • CE certificate can be printed or stored in your account • Questions about CEs, contact Joycambe@empireliverfoundation.org For Additional Information • Visit https://empireliverfoundation.org/about-us/cme-accreditation/
Disclosures • No Disclosures
Learning Objectives By the end of this presentation, participants will be able to: • Understand how to diagnose patients infected with hepatitis B virus (HBV) • Determine whether a patient needs active treatment and monitoring or monitoring only • Learn what medications are available to treat HBV
Interpreting Hepatitis B Tests
Clinical state HBsAg anti-HBs anti-HBc Action
Chronic infection + - + Link to HBV-directed care
Acute infection + - + Provide or link to HBV-
(IgM anti-HBc) directed care
Resolved infection - + + Counseling, reassurance,
monitor if undergoing
Immunosuppressive Rx
Immune (immunization) - + - Reassurance
Susceptible (never infected or - - - Vaccinate
immunized)
Unclear (maybe: false positive, - - + Consider checking the
resolved infection, “low level” chronic
infection, or resolving acute infection) HBV DNA
www.cdc.gov/hepatitis
Pre-Treatment Evaluation
History and Physical Examination
• Risk factors for viral hepatitis • Complete physical
• Risk factors for HIV co-infection examination
– Hepatomegaly
• Duration of infection
– Splenomegaly
• Alcohol history – Jaundice
• Presence of comorbid diseases – Distended abdomen
• Family history of liver cancer – Spider angiomata
Martin P et al. Clin Gastroenterol Hepatol 2015;13:2071.Pre-Treatment Blood Tests
• Serial testing of ALT and HBV • Testing for other viruses:
DNA level for 6 months – anti-hepatitis A virus Ig G (vaccinate as
• CBC, Liver enzymes , needed)
prothrombin time/INR – anti-HCV Ab
• Urinalysis – anti-HDV Ab
• HBeAg and anti-HBe – anti-HEV Ab (particularly in acute
hepatitis)
• HBV genotype including
resistance testing and basal – anti-HIV Ab
core promoter mutation • Testing for other liver diseases in
patients with abnormal liver tests:
– ANA, ASMA
– Fe/TIBC/ferritin
Martin P et al. Clin Gastroenterol Hepatol 2015;13:2071.Assessing Disease Severity • Assess the severity of liver disease: – FIB-4, APRI – Transient elastography – MR elastography • Screening for liver cancer – Ultrasound every-6-months – AFP every-6-months – MRI in cirrhotics
Non-Invasive Formulas to
Assess Severity of Fibrosis
APRI
FIB-4Goals of HBV Therapy
Goals of HBV Therapy
Improve liver
histology
Decrease serum
HBV DNA levels Prevention of
death, cirrhosis,
Seroconversion and HCC
(loss of HBeAg,
development of anti-HBe,
loss of HBsAg,
development of anti-HBs)
ALT normalizationWhat About A Cure? Types Of HBV Cure
• Inactive state
– Sustained, off drug
• No inflammation – Normal ALT
• HBVDNA low or undetectable
• HBsAg positive
• Functional Cure (Clinical Resolution)
– Sustained, off drug
• No inflammation – Normal ALT
• HBsAg loss
• Anti-HBs gain sometimes
• Complete Cure (Virologic Cure)
– All of the above plus
– Loss of cccDNA in the liver
– Loss of integrated HBV DNA in hepatocytesHBV Therapy Reverses Fibrosis and Cirrhosis
100%
489 patients complete 240 weeks Ishak Fibrosis Score
(4.6 years) of treatment with tenofovir 90% 6
80% 5
Percentage of Patients
• 348 patients have a biopsy at 4
baseline and week 240 70% 3
60% 2
• 304 patients (87%) have 1
50% 0
histological improvement at week
240 40%
30%
• 176 patients (51%) have
regression of fibrosis at week 240 20%
10%
• 71 / 96 (74%) with cirrhosis
(Ishak Score ≥5) at baseline no 0
longer had cirrhosis at week 240 Baseline Year 1 Year 5
Marcellin P et al. Lancet 2013;381:468.HBV Therapy Reduces Risk of
Disease Progression
651 patients with HBV cirrhosis
• 436 receive lamivudine
• 215 receive placebo
Primary end point =
development of:
• Deteriorating liver function
• Variceal bleed
• Spontaneous bacterial
peritonitis
• Hepatocellular carcinoma
• Death due to liver disease
Liaw YF et al. N Engl J Med.
2004;351:1521.HBV Therapy Reduces Liver Cancer Risk
Reference Treated pts/ Type of NUC used Median Incidence of P value
Untreated pts study follow-up HCC:
% treated /
% untreated
Liaw, 436/215 RCT, LAM vs. 2.7 years 3.9% / 7.4% 0.047
2004 prospective placebo
Yuen, 142/104 Prospective LAM 8.2 years 0.7% / 2.4% 0.005
2007
Papatheodo 21 studies Systematic LAM 3.8 years 2.8% / 6.4% 0.003
ridis, 3881/534 review
2010
Singal, 49 studies Meta- LAM, ADV, --- 3.3 vs. 9.7 per < 0.0001
2013 10025/3571 analysis ETV, LdT, 100 person
TDF years
*Hepatic decompensation, HCC, spontaneous
bacterial peritonitis, bleeding gastroesophageal varices, or death related to liver disease.
Rapti I, Hadziyannis S. World J Hepatol 2015;7:1064.Making A Decision To Treat
New Nomenclature For Chronic Hepatitis B
HBeAg positive HBeAg negative
Chronic Chronic Chronic Chronic Resolved
infection hepatitis infection hepatitis infection
Phase 1 Phase 2 Phase 3 Phase 4 Phase 5
High/
HBsAg High Low Intermediate Negative
intermediate
HBeAg Positive Positive Negative Negative Negative
HBV DNA >107 IU/mL 104–107 IU/mL 2,000 IU/mLHBV Treatment and Monitoring:
EASL Recommendations
• All patients with HBeAg-positive or -negative chronic hepatitis B, defined by
HBV DNA >2,000 IU/ml, ALT >ULN and/or at least moderate liver
necroinflammation or fibrosis, should be treated.
• Patients with compensated or decompensated cirrhosis need treatment, with
any detectable HBV DNA level and regardless of ALT levels.
• Patients who are not candidates for antiviral therapy should be monitored
with periodical assessments of serum ALT and HBV DNA levels as well as for
liver fibrosis severity by non-invasive markers.
European Association for the Study
of the Liver. J Hepatol 2017;67:370.HBV Management in Primary Care
Role of Primary Care and Specialists in
HBV Management
What can be managed in primary care? What should be referred to a liver
specialist?
• HBV screening and interpretation for all patients • Liver lesion on imaging suspicious for HCC
• HBV and HAV vaccination for all patients (e.g. US LI-RADS3, CT-MRI LI-RADS 5)
• Initial evaluation and counseling of the HBsAg(+) patients • Compensated and decompensated cirrhosis
• Substance use screening/harm reduction counseling • Hepatitis D co-infection (requires interferon
• Smoking cessation treatment)
• Alcohol moderation/abstinence counseling • Persistent elevation of liver enzymes that do
• Management of metabolic syndrome risk factors not correlate with HBV DNA levels or
• HBV lab monitoring every 6 months metabolic syndrome risk factors (may need
• Liver cancer surveillance liver biopsy)
Dependent on comfort level of the primary care provider, may be managed in primary care or in
consultation with a specialist:
• Initiation of and monitoring on HBV antiviral treatment
• Perinatal HBV management
Wang et al, Current Hepatology Reports 2021.Management of HBsAg(+) Patient:
HBV Primary Care Workgroup Recommendations
Fibrosis HBV DNA ALT
Cirrhosis Treat
Elevated* Treat
HBsAg +ve
>2,000 IU/mL
Normal
Non-cirrhotic
Elevated* Monitor
≤2,000 IU/mL
Normal
*Elevated ALT defined as >25 U/L in females and >35
U/L in males that is persistent for at least 3 to 6 months
https://www.hepatitisb.uw.edu/page/primary-care-workgroup/guidanceHBV Primary Care Workgroup Recommendations:
Assessing for Treatment Response
Assessing for treatment response
• After initiation of HBV antiviral therapy:
– Recheck HBV DNA every 3 months until undetectable
– Once undetectable, recheck HBV DNA every 6 months
• Refer to specialist or obtain expert consultation if:
– Patient does not achieve undetectable HBV DNA after 1 year of antiviral therapy
– HBV DNA levels are not downtrending
https://www.hepatitisb.uw.edu/page/primary-care-workgroup/guidanceHBV Primary Care Workgroup Recommendations:
Management of HBsAg(+) Patient
Cirrhosis HBV ALT Management
DNA
Yes Any Any • Treat
• Refer to specialist for screening endoscopy
• HCC surveillance every 6 months
• If decompensated cirrhosis, refer to hepatologist
>2,000 Elevated* • Treat
Monitor HBV • If HBeAg(+), monitor HBeAg, anti-Hbe every 6
DNA and ALT months for seroconversion to HBeAg(-)/anti-Hbe(+)
every 6 months
• Check HBsAg annually if/when HBeAg negative
No
≤2,000 Normal • Assess liver fibrosis every 2 to 3 years
>2,000 Elevated* • Evaluate other etiologies for elevated ALT
≤2,000 Normal • Check HBsAg every 1 year for seroclearance
https://www.hepatitisb.uw.edu/page/primary-care-workgroup/guidanceHBV Primary Care Workgroup Recommendations:
Endpoints for Antiviral Discontinuation
Cirrhosis HBeAg Endpoint for Antiviral Discontinuation
Do not stop antiviral treatment, unless guided by expert
Yes
consultation
Patients with the following may trial off antiviral treatment:
• persistent undetectable HBV DNA
Positive at • normal ALT
No
baseline • persistent HBeAg(-) and anti-HBe(+) 1 year after
HBeAg seroconversion [from HBeAg(+)/anti-HBe(-) to
HBeAg(-)/anti-HBe(+)]
Negative at
No Continue antiviral treatment until HBsAg clearance
baseline
https://www.hepatitisb.uw.edu/page/primary-care-workgroup/guidanceHBV Treatment Options
Evolution of Hepatitis B Therapy
Peginterferon alfa-2a.
(Pegasys®) Tenofovir
disoproxil Tenofovir
Lamivudine Entecavir fumarate alafenamide
(Epivir®)* (Baraclude®) (Viread®) (Vemlidy®)
1991 1998 2002 2005 2006 2008 2016
Interferon alfa-2b Adefovir Telbivudine
(Intron A®) (Hepsera®)* (Tyzeka®)*
In use
* Nucleoside/nucleotide analogues with a low barrier against No longer in use
HBV resistanceHBV Resistance To Nucleoside /
Nucleotide Analogues
Cumulative incidence of HBV resistance to NAs in pivotal
trials in NA-naïve patients with chronic hepatitis B†
80
70 1 year
70 67 2 years
3 years
60
4 years
50 49 5 years
40 38
30 29
24
20 18 17
11
10
3 4 1.2
0 0.2 0.5 0 0 0 0 0 0 0
0
LAM ADV TBV ETV TDF† TAF
*Evidence level I, grade of recommendation 1; †Collation of currently available data – not from head-to-head studies;
‡
No evidence of resistance has been shown after 8 years of TDF treatment
EASL CPG HBV. J Hepatol 2017;67:370–98Efficacy of Therapy
HBeAg positive PegIFNa2a Entecavir TDF TAF
chronic hepatitis B Dose 180 µg 0.5 mg 245 mg 25 mg
Results after 48-52
weeks of therapy Anti-HBe seroconversion 32% 21% 21% 10%
HBV DNA < 60-80 IU/mL 14% 67% 76% 64%
ALT normalization 41% 68% 68% 72%
HBsAg loss 3% 2% 3% 1%
HBeAg negative PegIFNa2a Entecavir TDF TAF
chronic hepatitis B Dose 180 µg 0.5 mg 245 mg 25 mg
Results after 48-52
HBV DNA < 60-80 IU/mL 19% 90% 93% 94%
weeks of therapy
ALT normalization 59% 78% 76% 83%
HBsAg loss 4% 0% 0% 0%
EASL CPG HBV. J Hepatol 2017;67:370–98Anti-Viral Treatment Options for HBV
Name Anti-viral Side effects Risk of Caveats
potency resistance
Peg-IFN ++ Fatigue, None May be effective in patients with HBV
alfa 2a cytopenias, genotype A.
depression Not recommended in cirrhosis,
cardiopulmonary disease, psychiatric
disease, uncontrolled seizures,
pregnancy
Entecavir +++ Lactic acidosis Very low Not recommended if prior nucleoside
in decompensated analogue treatment
cirrhosis. Dose adjustment if Cr cl < 50 ml/min
? renal toxicity
TDF +++ Renal and bone Very low Dose adjustment if Cr cl < 50 ml/min
toxicity
TAF +++ Minimal renal and Very low Dose adjustment if Cr cl < 15 ml/min
bone toxicitySelecting A Medication
Prior exposure to a nucleoside/ Prefer TAF to
nucleotide analogue ETV
Bone disease
• Chronic steroid use Prefer ETV or
• Osteoporosis TAF to TDF
• History of compression fracture
Renal dysfunction
• GFR < 60 ml/min/1.73m2 Prefer ETV or
• Albuminuria > 30 mg/24 h
• Low phosphate (< 2.5 mg/dL)
TAF to TDF
• Hemodialysis
Prefer ETV or
? Age > 60 years ?
EASL CPG HBV. TAF to TDF
J Hepatol
2017;67:370–98Monitoring of CHB Patients on Treatment
HBV DNA
• Every 3 months until undetectable
• Every 3-6 months thereafter
ALT
• Every 3 months until undetectable
Treatment • Every 3-6 months thereafter
Initiation
HBeAg HBeAg – Anti-HBe
positive Every 6 months until negative
HBeAg Once sustained suppression HBsAg +
negative HBV DNA is achieved Every 12 monthsMonitoring of Renal Function • No formal recommendations at this time • Renal dysfunction can be seen in patients on NAs, particularly for patients on tenofovir disoproxil fumarate (TDF). • Consider every 6 month check of: ⎼ Serum phosphorus ⎼ Serum uric acid ⎼ Urinalysis
When To Stop Treatment
• Treat until seroconversion to anti-Hbe most people don’t do this.
Seroreversion rate is about 75% at 5 years so silly to stop
• Continue with consolidation therapy for at least 1-2 years
HBeAg • After stopping therapy, monitor for relapse:
positive ⎻ Seroconversion to HBeAg positivity
⎻ Reappearance of HBV DNA
⎻ ALT elevation
• Continue antiviral therapy for life
• Treatment may be stopped if:
HBeAg
⎼ If HBsAg becomes negative, treatment may be stopped
negative ⎼ If HBV DNA is undetectable for > 3 years.*
• Monitor closely for relapse
Cirrhosis • Continue antiviral therapy for life
Terrault NA et al. Hepatology 2016;63:261. *EASL CPG HBV. J Hepatol 2017;67:370–98Management of Patients with
Prior Treatment Failure
Treatment should be adapted as soon as virologic failure under NAs is confirmed*
Resistance Pattern Recommended Rescue Strategies
LAM resistance Switch to TDF or TAF
TBV resistance Switch to TDF or TAF
ETV resistance Switch to TDF or TAF
If LAM-naïve: switch to ETV or TDF or TAF
ADV resistance If LAM-resistant: switch to TDF or TAF
If HBV DNA plateaus: add ETV† or switch to ETV
If LAM-naïve: switch to ETV
TDF or TAF resistance‡
If LAM-resistant: add ETV§
Multidrug resistance Switch to ETV + TDF or TAF combination
*Evidence level II-1, grade of recommendation 1; †Especially in patients with ADV-resistant mutations (rA181T/V and/or rN236T) and
high viral load, the response to TDF (TAF) can be protracted; ‡Not seen clinically so far; do genotyping and phenotyping in an expert
laboratory to determine the cross-resistance profile; §The long-term safety of these combinations is unknown
EASL CPG HBV. J Hepatol 2017;67:370–98Case Study
• 36 year old Asian women • What do you do now?
• History of hepatitis B with risk – Initiate HBV anti-viral therapy
factor pre-natal transmission – Screen for HCC q 6 months
• Feels well – Monitor ALT and HBV DNA q 6
months
• ALT 55 – Contact screening and
• HBV DNA 120,000 IU vaccination
• Platelet count 185,000
• HBsAg+
• HBeAg+
• F1 on transient elastographyHBV Treatment Access
• Uninsured or underinsured patients may not be able to afford costs of
specialty care, including co-payment and co-insurance
• Uninsured or underinsured patients may benefit from HBV patient assistance
programs: https://www.hepb.org/treatment-and-
management/treatment/patient-assistance-programs-in-the-u-s/
• HBV patient navigators can help uninsured or underinsured patients access
treatment
– Check Hep B Patient Navigation offers multilingual patient navigation services to people
living with HBV in NYC: https://hepfree.nyc/check-hep-b-patient-navigation-program/HBV Treatment During Pregnancy
Treatment Approach to
HBsAg-Positive Mothers During Pregnancy
https://www.hepatitisb.uw.edu/go/prevention-hbv/preventing-perinatal-transmission-hbv/core-concept/allPerinatal HBV Treatment and Monitoring
Patients who do not meet criteria for Patients who meet criteria for antiviral
antiviral therapy for maternal benefit therapy for maternal benefit
• Monitor ALT for hepatitis flares due to • Continue on therapy indefinitely
pregnancy-associated immunologic − Treatment endpoints for pregnant people is
changes same as for nonpregnant people
− Every 3 months during pregnancy and for six
• Tenofovir DF preferred agent postpartum as
months postpartum
safe for breastfeeding
• Check HBV DNA at 26 to 28 weeks
− After breastfeeding stops, consider
gestation to determine need for antiviral switching to either tenofovir alafenamide or
initiation entecavir if indicated or preferred
• Discontinue tenofovir DF at delivery
https://www.hepatitisb.uw.edu/go/prevention-hbv/preventing-perinatal-transmission-hbv/core-concept/allPrevention of Secondary HBV Transmission
During and After Pregnancy
Contact Prevention strategy
Newborn • Treatment of mother (if HBV DNA >200,000 IU/mL)
• HBIG and HBV birth dose within 12 hours
• Full vaccination series
• Post-vaccination serology testing
Other children and • Screen for HBV susceptibility
household contacts • Full vaccination series
Sexual partner(s) • Screen for HBV susceptibility
• Full vaccination series
• Safe sex methods until immunity confirmed
Drug sharing partner(s) • Screen for HBV susceptibility
• Full vaccination series
• Harm reduction
Utilize the NYC Health Department Perinatal HBV Prevention Program to support case management of contact
screening and vaccination: https://www1.nyc.gov/site/doh/providers/health-topics/hepatitis-b-and-pregnancy.page.Prevention of HBV Reactivation During Immunosuppressive Drug Therapy
Patients Undergoing Immunosuppressive
Therapy or Chemotherapy
Case:
• 40-year-old woman with rheumatoid arthritis has an inadequate response to
anti-TNF agents.
• Rheumatology plans to start rituximab in combination with methotrexate next
week.
• Labs:
⎻ Liver chemistries: normal.
⎻ HBcAb (total): positive.
⎻ HBsAg: negative.
⎻ HBsAb: negative.
• What is your response?
Rajender Reddy K et al. American Gastroenterological Association Institute guideline on the prevention and treatment of hepatitis B virus reactivation during
immunosuppressive drug therapy. Gastroenterol 2015;148:215.Monitoring HBV-Exposed Patients on
Immunosuppression: Treat Prophylactically?
HBVR, HEPATITIS B VIRUS REACTIVATION; HBCAB+, ANTI-HBC-POSITIVE
REDDY KR, ET AL. GASTROENTEROLOGY. 2015;148:215–219.AGA Guideline on Prophylaxis of HBV Reactivation
During Immunosuppressive Drug Therapy
HBVR, HEPATITIS B VIRUS REACTIVATION; HBCAB+, ANTI-HBC-POSITIVE
REDDY KR, ET AL. GASTROENTEROLOGY. 2015;148:215–219.Summary
Case Study
• 43-year-old Asian woman sent to specialist for chronic HBV and liver lesions
– Diagnosed with chronic HBV at prenatal checkup 9 years ago. Mother died of liver cancer at
age of 58. Patient started on TDF in 2015 at outside facility, but took it irregularly. On TDF for
8 months and self-discontinued in 2016 when she ran out of medications and felt fine.
• Patient was hospitalized (1/30-2/2/2017) for abdominal pain
– Abdominal MRI revealed 7.2 cm LI-RADS 4 left hepatic mass, additional satellite lesions
– Labs: AST 51, ALT 24, HBsAg positive, eAg negative, anti-HBe positive, HBV DNA 26 (IU/ml),
AFP 387,800, INR 1.0, WBC 8.4, Hb 15.7, platelets 246,000, anti-HCV negative, and HCV
RNA negative, immune to HAV
• Restarted on TDF, seen by surgical oncology, IR, and oncology, scheduled for left
trisegmentectomy for multifocal bilobar HCC.
– At ex-lap, it showed additional segment 7 lesion; patient deemed inoperable.
– Segment 6 wedge resection revealed moderately differentiated HCC and liver biopsy showed
chronic HBV with focal bridging fibrosis.
– Patient was referred to liver transplant for evaluation.Summary • Effective therapies are available to treat chronic HBV infection • HBV is not a curable disease at this time • Appropriate patients should be placed on HBV therapy • HBV therapy is usually lifelong • All patients, whether on therapy or not, should be monitored for the development of HCC • Hepatitis B therapy may be indicated in pregnant people to prevent mother-to-child transmission
New York State HBV Clinical Capacity Building Resources
HBV Training Opportunities & Resources in NYS
There are many HBV training opportunities and resources, most
offering CMEs:
• CME training (live/webinar) on HBV care and treatment
• HBV evaluation and linkage to care guidance and technical
assistance
• HBV clinical preceptorships
www.hepfree.nyc
To learn more contact: Hep@health.nyc.gov
Or contact the NYC Health Department Warm line: 917-890-0834Additional Clinical Resources • National Task Force on Hepatitis B: www.hepbtaskforce.org • University of Washington Hepatitis B Online: https://www.hepatitisb.uw.edu • Stanford Health Care: https://stanfordhealthcare.org/medical- conditions/liver-kidneys-and-urinary-system/hepatitis-b.html
HBV Care Resources in NYC
• Check Hep B Patient Navigation Program
– Provides free or low cost Hep B Patient Navigation services at eight organizations in
NYC. Patient Navigators assist patients with complete testing, linkage to care, support
through a full medical evaluation and treatment if recommended.
https://hepfree.nyc/check-hep-b-patient-navigation-program/
• Linkage to Care Affordable Care Support
– Health Department HBV testing and care services listing
• www.nyc.gov/health/hepb
• NYC Health Department Health Map
– Health Care Access Specialist
• 917-890-0834
• Hep@health.nyc.govHBV Care Resources in NYC • Patient Assistance Programs – cover the cost of medication and copays for uninsured • Order HBV Patient Education Materials: Hep@health.nyc.gov • NYC Hep B Coalition: www.HepFree.NYC
Additional Clinical Guidance Prevention: • HBV vaccines: https://www.hepatitisb.uw.edu/page/treatment/vaccines • Perinatal HBV prevention: https://www1.nyc.gov/site/doh/providers/health-topics/hepatitis-b-and- pregnancy.page Screening: • USPSTF screening guidelines: https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/hepatitis-b-virus-infection- screening • HBV Primary Care Workgroup recommendations: https://www.hepatitisb.uw.edu/page/primary-care- workgroup/guidance • HBV screening tests: https://www.hepatitisb.uw.edu/go/screening-diagnosis/diagnosis-hbv/core- concept/all#recommended-screening-tests Patient education: • Order HBV patient education materials: Hep@health.nyc.gov
Contact Us
For CMEs or educational For questions about resources,
opportunities, contact: contact:
Meg Chappell, MPH Marie P. Bresnahan, MPH
Program Manager Director, Training, Policy, and
Empire Liver Foundation Administration
megchappell@empireliverfoundation.org Viral Hepatitis Program
www.empireliverfoundation.org Bureau of Communicable Disease
mbresnahan@health.nyc.gov
www.hepfree.nycHow to Stay Connected
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http://bit.ly/HepFreeNYCSubscribeHBV Provider Training Series & Upcoming Webinars
Date Topic
January 13, 2022 Hepatitis B : Epidemiology, Prevention and
Screening with Dr. Paul Gaglio
January 20, 2022 Hepatitis B Pre- Treatment Evaluation and
Treatment Initiation with Dr. Lisa Ganjhu
January 27, 2022 Management of Hepatitis B and Treatment
Monitoring with Dr. Harmit Kalia
February 3, 2022 Hepatitis B and Pregnancy with Dr. Tatyana
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