HBV Case for Discussion at Project ECHO meeting Liverpool Hospital

Referring Dr
Patient name and DOB:
Gender:
Date:

Year CHB Diagnosed if known

Country of Birth

Family history HBV or liver cancer

Indigenous yes /no

Other possible transmission risk:

Medical history:	Allergies:
Current medications:

Liver health assessment:

Chronic Hepatitis B/other viral hepatitis	Baseline blood tests date:
HBsAg	+	-	HBeAg	+	-	HCV Ab	+	-	HCV RNA	+	-
HBcAb	+	-	HBeAb	+	-	Hepatitis D (Delta) antibody	+	-
Details of previous antiviral therapy:
Imaging / Elastrography (Fibroscan) date:
Metabolic liver disease risks	DM2	Y	N	HbA1c:
Overweight/obese	Height	cm	Weight	kg	BMI
Substance use issues	Smoking pack years:
Alcohol daily standard units (average):	Other (IDU, other illicit):

Symptoms / signs of CLD:

Dynamic Investigations/monitoring (re use same form in future discussions)

Date	ALT	HBeAg/eAb	HBV DNA *	HBV Treatment (nil or name it)	APRI or Fibroscan	HCC Surveillance (Modality US/CT/MRI) Lesions? Cirrhosis?

* HBV DNA is only funded once a year if patient is not on antiviral therapy.

Routine 6 monthly HCC surveillance indicated for Asian women >50, men >40, Africans over 20 years, cirrhotics or family history of liver cancer

Comments

ECHO MEETING ADVICE:

Checklist for discussion with patient:

☐Natural history of HBV	☐ Transmission and prevention	☐ Self-management advice
☐ Treatment options	☐ The importance of adherence	☐Treatment may be lifelong
☐ Importance of regular monitoring	☐ Testing and vaccination of household/family contacts	☐ Provided written info / resource list

PHASES OF CHRONIC HEPATITIS B:

Phase	HBV DNA (IU/mL)	HbeAg	HbeAb	ALT	Management
Tolerant (HBeAg pos infection)	>20 000	+	-	Normal	Monitor
Clearance (Hepatitis)	>20 000	+	-	Raised	Consider Rx
Control (HBeAg neg infection)	<2000	-	+	Normal	Monitor
Escape (Hepatitis)	>2000	-	+	Raised	Consider Rx

NON-INVASIVE FIBROSIS TESTING:

Non-invasive fibrosis estimation is recommended in all cases to assess for signs of advanced fibrosis or cirrhosis http://www.hepatitisc.uw.edu/page/clinical-calculators/apri
APRI	FIB4	FIBROSCAN
Use AST and platelets, <1 negative predictive value 93% for cirrhosis > 1 proceed to fibroscan	<1.45 negative predictive value 90% for adv fibrosis/cirrhosis	<5	No/minimal fibrosis
5-6	Low probability of significant fibrosis
>6-9	Difficult to interpret
>9-12	Significant fibrosis
>12	Possible cirrhosis