Chronic hepatitis B (CHB) continues to be a significantly untreated disease in the United States. Two-thirds of the estimated 1.25 million hepatitis B carriers in the United States do not know they are infected and are unlikely to discover their status until they show signs of potentially life-threatening illnesses. Carriers of hepatitis B virus (HBV) are at increased risk for developing cirrhosis, hepatic decompensation, and hepatocellular carcinoma (HCC), with 15% to 40% developing these serious hepatic complications in their lifetime. There is an urgent need to screen, diagnose, and treat CHB to prevent further spread and reduce morbidity and mortality associated with CHB.

At this case-based web posting, experts will discuss the significant advances that have been made in the past 5 years in our understanding of the natural history of hepatitis B and the management of patients with CHB. In addition, the 2009 American Association for the Study of Liver Diseases (AASLD) Practice Guidelines and the most recent European Association for Study of the Liver (EASL) Cinical Practice Guidelines will be examined. Pregnancy in the patient with CHB also presents the provider with a unique set of management challenges which will be addressed by the Faculty. These include maternal and fetal effects of hepatitis B, effects of pregnancy itself on the course of hepatitis B infection and its complications, treatment of hepatitis B during pregnancy, and prevention of perinatal infection. In addition, patients with hepatitis B undergoing immunosuppressive or cancer chemotherapy present a different set of challenges for the provider, including prophylactic antiviral therapy and timing of initiation of chemotherapy. These challenges, among others, will be addressed in terms of the 2009 AASLD Practice Guidelines and the 2010 American Society of Clinical Oncology Clinical Practice Guidelines.

This activity is designed for hepatologists and gastroenterologists who treat patients with CHB.

After completing this activity, the participant should be better able to:

• Integrate the 2009 AASLD Practice Guidelines into clinical practice with respect to screening at-risk patients, treatment timing, selection of agents and duration of treatment
  
• Develop treatment strategies for the management of pregnant women with CHB and for the prevention of perinatal infection in newborns
  
• Develop management strategies for HBV carriers undergoing immunosuppressive or cytotoxic therapy

Accreditation Statement

This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of Postgraduate Institute for Medicine (PIM) and HealthmattersCME. PIM is accredited by the ACCME to provide continuing medical education for physicians.

Credit Designation

Postgraduate Institute for Medicine designates this educational activity for a maximum of 2.25 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Postgraduate Institute for Medicine (PIM) assesses conflict of interest with its instructors, planners, managers, and other individuals who are in a position to control the content of CME activities. All relevant conflicts of interest that are identified are thoroughly vetted by PIM for fair balance, scientific objectivity of studies mentioned in this activity, and patient care recommendations. PIM is committed to providing its learners with high-quality CME activities and related materials that promote improvements or quality in health care and not a specific proprietary business interest of a commercial interest.

The faculty reported the following financial relationships or relationships to products or devices they or their spouse/life partner have with commercial interests related to the content of this CME activity:

Eugene R. Schiff, MD, MACP, FRCP, MACG, AGAF
Contracted Research: Abbott; Anadys; Bristol-Myers Squibb; Gilead Sciences, Inc; GlobeImmune, Inc; Medtronic; Merck & Co; Roche Diagnostics; Roche Molecular; Salix Pharmaceuticals, Inc; Sanofi-Aventis; Schering-Plough; Sciclone; Vertex Pharmaceuticals
Fees for Non-CME/CE Services: Scientific Advisory Board (SAB): Bristol-Myers Squibb;Gilead Sciences, Inc; GlobeImmune, Inc; Johnson and Johnson; Merck & Co; Roche Molecular; Schering-Plough; Vertex Pharmaceuticals; Data Safety Monitoring Board
(DSMB): Daiichi-Sankyo; Johnson and Johnson; Pfizer Inc; Salix Pharmaceuticals, Inc;Sanofi-Aventis

Robert Gish, MD
Consulting Fees: Abbott; Astellas/OSI; Bayer AG; Bristol-Myers Squibb; Durect; Genentech/Hoffmann-LaRoche Ltd; Gilead Sciences, Inc; GlaxoSmithKline; GlobeImmune; Hepahope; Pharmasset; ZymoGenetics
Contracted Research: Bayer-Onyx; Bristol-Myers Squibb; Genentech/F. Hoffman-LaRoche Ltd; Gilead Sciences, Inc; Pharmasset; ZymoGenetics
Fees for Non-CME/CE Services: Bayer; Bristol-Myers Squibb; Genentech/F. Hoffman-LaRoche Ltd; Gilead Sciences, Inc; GlaxoSmithKline; Onyx; Salix Pharmaceuticals, Inc
Other: I.C. Stock: Hepahope

Mark Sulkowski, MD
Consulting Fees: Bristol-Myers Squibb; Genentech/F. Hoffman-LaRoche Ltd; Gilead Sciences, Inc
Contracted Research: Bristol-Myers Squibb; Genentech/F. Hoffman-LaRoche Ltd; Gilead Sciences, Inc

Tram T. Tran, MD
Consulting Fees: Bristol-Myers Squibb; Gilead Sciences, Inc
Fees for Non-CME/CE Services: Bristol-Myers Squibb; Gilead Sciences, Inc

The planners and managers reported the following financial relationships or relationships to products or devices they or their spouse/life partner have with commercial interests related to the content of this CME activity:

The following PIM planners and managers, Jan Hixon, RN, BSN, MA, Trace Hutchison, PharmD, Julia Kimball, RN, BSN, Samantha Mattiucci, PharmD, Jan Schultz, RN, MSN, CCMEP, and Patricia Staples, MSN, NP-C, CCRN hereby state that they or their spouse/life partner do not have any financial relationships or relationships to products or devices with any commercial interest related to the content of this activity of any amount during the past 12 months.

The following HealthmattersCME planners and managers, James Murphy and Yaming Wang, MD,  hereby state that they or their spouse/life partner do not have any financial relationships or relationships to products or devices with any commercial interest related to the content of this activity of any amount during the past 12 months.

This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. Postgraduate Institute for Medicine (PIM), HealthmattersCME, and Gilead Sciences, Inc, do not recommend the use of any agent outside of the labeled indications.

The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of PIM, HealthmattersCME, and Gilead Sciences, Inc. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient's conditions and possible contraindications on dangers in use, review of any applicable manufacturer's product information, and comparison with recommendations of other authorities.

There are no fees for participating and receiving CME credit for this activity. During the period December 1, 2010 through December 1, 2011, participants must read the learning objectives and faculty disclosures and study the educational activity.

PIM supports Green CME by offering your Request for Credit online. If you wish to receive acknowledgment for completing this activity, please complete the post-test and evaluation on www.cmeuniversity.com. On the navigation menu, click on “Find Post-test/Evaluation by Course” and search by course ID 7585. Upon registering and successfully completing the post-test with a score of 70% or better and the activity evaluation, your certificate will be made available immediately. Processing credit requests online will reduce the amount of paper used by nearly 100,000 sheets per year.

• Internet Activity