An overview of the diagnosis and treatment of Hepatitis B and Hepatitis C. Primary care providers are the main audience for this presentation.

7. Hepatitis Epidemiology

8. Hepatitis C: The rising wave

9. Liver Transplantation

10. Risk Factors for Primary Hepatocellular Carcinoma

11. Hepatitis B and C Clinical Course: Springfield Mixing bowl vs I-95 Hepatitis B: Non-linear Springfield, VA Hepatitis C: Linear I-95 Chronic Infection Fibrosis Cirrhosis Hepatocellular Carcinoma Chronic Infection Fibrosis Cirrhosis Hepatocellular Carcinoma

12. Hepatitis B Virus Surface Antigen (HBS Ag)‏ Core Antigen (HBc)‏ Surface Ab (HBsAb)‏ Core Ab (HbsAb)‏ IgM Recent IgG Past

13. Hepatitis B Testing (see handout)‏

22. Chronic Hepatitis B: Viral load predicts cirrhosis risk Baseline HBV DNA Level, copies/mL >1 Million 100000-999999 10000-99999 300-9999 <300 Viral Load 20,000 7%-10% risk of cirrhosis at 5 years

23. Chronic Hepatitis B: Carcinoma without cirrhosis Hepatocellular Carcinoma Cirrhosis 30-50% Liver cancer Without cirrhosis

24. Hepatitis B: Viral load predicts carcinoma risk 14 12 10 8 6 4 2 0 0 1 2 3 4 5 6 7 8 9 10 11 12 13 Year of Follow-up Cumulative Incidence of HCC, % Chen CJ et al. JAMA 2006;295(1):65-73. Viral Load 20,000 5% risk of carcinoma at 10 years Baseline HBV DNA Level, copies/mL >1 Million 100000-999999 10000-99999 300-9999 <300

29. Hepatitis C

30. Hepatitis C Infection Natalie Cole Greg Altman Ken Watabe Evel Kneivel Gene Weingarten Pamela Anderson Naomi Judd

33. Hepatitis C: Route of infection

34. Hepatitis C: Disease Progression Liver Cancer Cirrhosis (Stage 4)‏ Normal (Stage 0)‏ Fibrosis (Stage 1)‏ Fibrosis (Stage 2)‏ Fibrosis (Stage 3)‏

35. Hepatitis C: Risk of Cirrhosis

38. HCV Treatment Response: Interferon weekly and Ribavirin twice daily

39. Hepatitis C: Sustained Response Rates 48 weeks 24 weeks

42. HCV Protease Inhibitors: Trials done by 2014