James A. McHugh, MD Swedish Family Medicine, Seattle, Wash
Samuel Cullison, MD
Joseph Apuzzio, MD Maternal Fetal Medicine, New Jersey Medical School, Newark
Joan M. Block, RN, BSN Hepatitis B Foundation, Doylestown, Pa Joan.block@hepb.org
Chari Cohen, MPH Hepatitis B Foundation, Doylestown, Pa
Shou Ling Leong, MD Family and Community Medicine, Penn State College of Medicine, Hershey
Thomas W. London, MD Fox Chase Cancer Center, Philadelphia, Pa
Robert J. McNellis, MPH, PA American Academy of Physician Assistants, Alexandria, Va
Richard L. Neubauer, MD, FACP Internal Medicine, Alaska Native Medical Center, Anchorage
Robert Perrillo, MD Division of Hepatology, Baylor University Medical Center, Dallas Tex
Robert Squires, MD, FAAP Division of Gastroenterology, Children’s Hospital of Pittsburgh, Pa
Dianne Tarrant, MSN, APRN, FNP-BC University of Alaska Anchorage School of Nursing, Anchorage
Brian J. McMahon, MD Liver Disease and Hepatitis Program, Alaska Native Tribal Health Consortium, Alaska Native Medical Center, Anchorage
The workshop, convened on March 10-11, 2010, was funded by the Hepatitis B Foundation, from its general operating funds. The Foundation is supported primarily by federal, state, and private grants and individual donations, and has small, unrestricted educational grants from Bristol-Myers Squibb, Gilead Sciences, Idenix, Merck, and Novartis. No commercial support was directly provided for the workshop.
Ms. Cohen owns stock in Bristol-Myers Squibb and Gilead, and served on the Bristol-Myers Squibb advocacy advisory board for hepatitis B in 2010. Dr. Perrillo serves on the speaker’s bureau for Bristol-Myers Squibb and Gilead Sciences, and is a consultant for Roche Pharmaceuticals and Gilead. Dr. McMahon’s spouse owns stock in GlaxoSmithKline. The remaining authors reported no potential conflict of interest relevant to this article.
Seeking out expertise in HBV patient management When a patient with chronic HBV infection has moved into the immune active phase, consult with a provider who has expertise in HBV—whether you choose to refer or to co-manage the patient with the specialist—to obtain advice on further work-up and development of a long-term management and treatment strategy. Individuals with small liver tumors identified on ultrasound or an elevated AFP level require immediate referral to a clinician who treats HCC, such as a transplant hepatologist.
Ensuring the health of pregnant women The CDC recommends that all pregnant women be tested for HBsAg at an early prenatal visit. Counsel women who are HBsAg-positive on what this status means for their own health, in addition to that of their newborn. If you are providing prenatal care, collect baseline data for ALT, HBe serology, and HBV DNA levels. Promptly refer any patient with an elevated ALT level to a specialist for care during pregnancy.
Acknowledgement
Medical writing services were provided by Theresa M. Wizemann, PhD, of Wizemann Scientific Communications, LLC, under contract with the Hepatitis B Foundation.
CORRESPONDENCE Joan M. Block, RN, BSN, executive director, Hepatitis B Foundation, 3805 Old Easton Road, Doylestown, PA 18902; joan.block@hepb.org
