Jekyll2024-03-24T18:28:15+00:00https://www.robertgish.com//Robert G. Gish Consultants, LLCProviding Medical Consulting Services to Pharma, CME Organizations, Academic and Private InstitutionsExperience and impact of stigma in people with chronic hepatitis B:2024-02-28T10:00:00+00:002024-02-28T10:00:00+00:00https://www.robertgish.com/blog/experience-and-impact-of-stigma-in-people-with-chronic-hepatitis-b<p><img src="/uploads/screenshot-2024-02-28-at-8-12-48-am.png" alt="" width="1270" height="380" /></p>
<p><strong>Experience and impact of stigma in people with chronic hepatitis B: a qualitative study in Asia, Europe, and the United States</strong></p>
<p><em>Abstract</em><br /><strong>Background</strong><br />People with chronic hepatitis B (CHB) commonly experience social and self-stigma. This study sought to understand the impacts of CHB-related stigma and a functional cure on stigma.</p>
<p><strong>Methods</strong><br />Adults with CHB with a wide range of age and education were recruited from 5 countries and participated in 90-minute qualitative, semi-structured interviews to explore concepts related to CHB-associated stigma and its impact. Participants answered open-ended concept-elicitation questions regarding their experience of social and self-stigma, and the potential impact of reduced CHB-related stigma.</p>
<p><strong>Results</strong><br />Sixty-three participants aged 25 to 71 years (15 from the United States and 12 each from China, Germany, Italy, and Japan) reported emotional, lifestyle, and social impacts of living with CHB, including prejudice, marginalization, and negative relationship and work experiences. Self-stigma led to low self-esteem, concealment of CHB status, and social withdrawal. Most participants stated a functional cure for hepatitis B would reduce self-stigma.</p>
<p><strong>Conclusions</strong><br />CHB-related social and self-stigma are widely prevalent and affect many aspects of life. A functional cure for hepatitis B may reduce social and self-stigma and substantially improve the health-related quality of life of people with CHB. Incorporating stigma into guidelines along with infectivity considerations may broaden the patient groups who should receive treatment.</p>
<p><a href="https://jumpshare.com/v/VU0YLZkMVDovzH5dgKjH" target="_blank" rel="noopener">Read Article</a></p>AFP L3 and DCP strongly predict early hepatocellular carcinoma recurrence after liver transplantation2024-02-21T10:00:00+00:002024-02-21T10:00:00+00:00https://www.robertgish.com/blog/AFP-L3-and-DCP-strongly-predict-early-hepatocellular-carcinoma-recurrence<p><img src="/uploads/screenshot-2024-02-28-at-8-14-34-am.png" alt="" width="1209" height="413" /></p>
<p><strong>AFP-L3 and DCP strongly predict early hepatocellular carcinoma recurrence after liver transplantation</strong></p>
<p><strong>Background & Aims</strong>: Alpha-fetoprotein (AFP) predicts hepatocellular carcinoma (HCC) recurrence after liver transplant (LT) but remains an imperfect biomarker. The role of DCP (des-gamma-carboxyprothrombin) and AFP-L3 (AFP bound to Lens culinaris agglutinin) in predicting HCC recurrence remains incompletely characterized. AFP-L3 and DCP could identify patients at high risk of post-transplant HCC recurrence and serve as liver transplant exclusion criteria to defer transplant until patients receive additional risk-reducing pre-transplant locoregional therapy.</p>
<p><strong>Methods</strong>: This prospective cohort study included consecutive patients with HCC who underwent LT (within or down-staged to Milan criteria) between 2017 and 2022. Pre-transplant AFP, AFP-L3, and DCP measurements were obtained. The primary endpoint was the ability of biomarkers to predict HCC recurrence-free survival.</p>
<p><strong>Results</strong>: This cohort included 285 patients with a median age of 67 (IQR 63-71). At LT, median biomarker values were AFP 5.0 ng/ml (IQR 3.0-12.1), AFP-L3 6.7% (0.5-13.2), and DCP 1.0 ng/ml (0.3-2.8). Most (94.7%) patients received pre-LT locoregional therapy. After a median post-LT follow-up of 3.1 years, HCC recurrence was observed in 18 (6.3%) patients. AFP-L3 and DCP outperformed AFP with C-statistics of 0.81 and 0.86 respectively, compared with 0.74 for AFP. A dual-biomarker combination of AFP-L3 >−15% and DCP >−7.5 predicted 61.1% of HCC recurrences, whereas HCC only recurred in 7 of 265 (2.6%) patients not meeting this threshold. The Kaplan-Meier recurrence-free survival rate at 3 years post-LT was 43.7% for patients with dualpositive biomarkers compared to 97.0% for all others (p <0.001).</p>
<p><strong>Conclusions</strong>: Dual-positivity for AFP-L3>− 15% and DCP>−7.5 strongly predicted post-LT HCC recurrence. This model could refine LT selection criteria and identify high-risk patients who require additional locoregional therapy prior to LT.</p>
<p><a href="https://jumpshare.com/v/gx5Ux2KHjMYEst0jJpKm" target="_blank" rel="noopener">Read Article</a></p>Researchers call for more flexible editorial conduct2024-02-12T10:00:00+00:002024-02-12T10:00:00+00:00https://www.robertgish.com/blog/researchers-call-for-more-flexible-editorial-conduct<p><img src="/uploads/screenshot-2024-02-12-at-5-52-46-pm.png" alt="" width="595" height="209" /></p>
<p><strong>Researchers call for more flexible editorial conduct rather than abruptly adopting only the new MASLD nomenclature</strong></p>
<p>To the Editors:<br />Since many of us participated in the multi-society Delphi consensus statement on fatty liver disease nomenclature, we were interested in a recent article by Younossi and colleagues investigating potential stigma among patients with non-alcoholic fatty liver disease (NAFLD) and among healthcare providers. The authors concluded that the perception of NAFLD stigma varied among patients, providers, geographic locations, and sub-specialties. Of particular interest, only 8% of patients and 38% of doctors perceived stigma with use of the term. European patients more commonly (57%) reported being comfortable with either term, with many selecting “fatty liver disease”. Of note, while the Asia-Pacific region is home to 60% of the world’s population, only 5% of the study population was from this region. Furthermore, only 48% of patients ever disclosed their disease to family members, a proportion which is not different from other diseases.</p>
<p><a href="https://jumpshare.com/v/yjxC4BI29uqdHfBIxuGd" target="_blank" rel="noopener">Read Article</a></p>Urgent need for lived experience in hepatitis B guideline development2024-02-06T10:00:00+00:002024-02-06T10:00:00+00:00https://www.robertgish.com/blog/urgent-need-for-lived-experience-in-hepatitis-b-guideline-development<p><img src="/uploads/screenshot-2024-02-12-at-5-46-13-pm.png" alt="" width="792" height="171" /></p>
<p><strong>Urgent need for lived experience in hepatitis B guideline development</strong><br /><br />Globally, nearly 300 million people live with hepatitis B virus (HBV), making it the most common chronic infection. Although mortality rates have remained stable for the past 20 years, two people die from HBV every minute. WHO has called for the elimination of hepatitis B as a public health threat by 2030, setting goals to prevent new infections through birth-dose vaccination and to prevent illness and death by improving testing, clinical management, and treatment. However, progress towards elimination has stalled.</p>
<p><a href="https://jumpshare.com/v/4rP72uBvtllDfuiyjliA" target="_blank" rel="noopener">Read Article</a></p>Hep Free Hawai‘i brochures2024-01-09T10:00:00+00:002024-01-09T10:00:00+00:00https://www.robertgish.com/blog/hep-free-hawai-i-brochures<p><img src="/uploads/screenshot-2024-01-12-at-10-20-11-am.png" alt="" width="940" height="446" /></p>
<p><strong>HBV Brochure Handouts</strong><br />Hep Free Hawai‘i is a coalition of local, national, and global partners dedicated to increasing viral hepatitis awareness and access to care throughout our state. Hep Free Hawai‘i thrives because we all work together, connecting our communities and our islands to make Hawai‘i truly “Hep Free.”</p>
<p>You can download all HBV Core brochures and they are available in several languages</p>
<ul>
<li><a href="https://app.box.com/s/ft8cl7emzz0g7doqzlq5dfrigjcsvkro" target="_blank">Hepatitis B Core Antibody Results (English)</a></li>
<li><a href="https://app.box.com/s/27iqtydj5ep2st7hrby3mgekl2zj6vbi" target="_blank">了解您的乙型肝炎檢測結果 (Chinese)</a></li>
<li><a href="https://app.box.com/s/kp0skno61sz3zig6m6e43xkg4i9oowq9" target="_blank">Weweiti pungun om tesin Hepatitis B (Hep B) (Chuukese)</a></li>
<li><a href="https://app.box.com/s/usvznhnc5ekxsmtmeuuqptah6mpvljgk" target="_blank">Comprendre les résultats de votre test de l’hépatite B (Hep B) (French)</a></li>
<li><a href="https://app.box.com/s/3794bj5edh1jvqjvdwbrg6f29tc7mt45" target="_blank">He aha ka mana’o o ka hopena o kāu hō’ike hepatitis B (Hep B) (Hawaiian)</a></li>
<li><a href="https://app.box.com/s/3ds3ff7k52l3ps8f2n2wx9u2af49qq8l" target="_blank">Pannakaitarus Dagiti Resulta ti Hepatitis B (Hep B) (Ilocano)</a></li>
<li><a href="https://app.box.com/s/blmseh54szqq8lrce58oxhklbno97ftc" target="_blank">Memahami hasil test hepatitis (Hep B) anda (Indonesian)</a></li>
<li><a href="https://app.box.com/s/65g2ml5wmgol4tk8cibppx8hfaozw0ib" target="_blank">B 형 간염 결과 이해 (Korean)</a></li>
<li><a href="https://app.box.com/s/2tz6f59tqzciyqwvxohzensvpnaftb38" target="_blank">Ñon Am Melele Kin Enan in Hepatitis B (Hep B) Test Eo Am (Marshallese)</a></li>
<li><a href="https://app.box.com/s/ffe6nijqbe5oc4hrs6pjocsf4vz1ihid" target="_blank">Pagkaunawa Tungkol sa Resulta ng Pag-iksamen sa Iyong Hepatitis B (Hep B) (Tagalog)</a></li>
<li><a href="https://app.box.com/s/dp0neb691pqlyuzpy4yu0wqj79euueq3" target="_blank">Hiểu biết về kết quả xét nghiệm viêm gan B của bạn (Vietnamese)</a></li>
</ul>The importance of triple panel testing for hepatitis B2023-12-18T10:00:00+00:002023-12-18T10:00:00+00:00https://www.robertgish.com/blog/the-importance-of-triple-panel-testing-for-hepatitis-b<p><img src="/uploads/screenshot-2023-12-18-at-1-59-29-pm.png" alt="" width="600" height="207" /></p>
<p><strong>The importance of triple panel testing for hepatitis B and the burden of isolated anti-hepatitis B core antibodies within a community sample</strong></p>
<p><em>Abstract</em><br />Within the United States (US), 2.4 million individuals are living with chronic hepatitis B, but less than 20% are diagnosed. Isolated anti-hepatitis B core (iAHBc) antibodies indicate serology in an individual that is positive for anti-HBc antibodies, while negative for surface antigen (HBsAg) and surface antibodies (anti-HBs). A result of iAHBc could indicate a chronic occult bloodstream infection, necessitating further testing. This study assesses the prevalence and risk factors associated with anti-HBc and iAHBc within community high-risk screening in Greater Philadelphia. Participants (n = 177) were screened for HBsAg, anti-HBs, and anti-HBc during community screening events in 2022. </p>
<p><a href="https://www.sciencedirect.com/science/article/pii/S2055664023000444?via%3Dihub" target="_blank" rel="noopener">Read Article</a></p>Advances in Viral Hepatitis B and D: Moving Toward the Goals of Elimination2023-11-22T10:00:00+00:002023-11-22T10:00:00+00:00https://www.robertgish.com/blog/advances-in-viral-hepatitis-b-and-d-moving-toward-the-goals-of-elimination<p><img src="/uploads/screenshot-2023-11-22-at-9-57-47-am.png" alt="" width="1656" height="816" /></p>
<p><strong>Advances in Viral Hepatitis B and D: Moving Toward the Goals of Elimination., An Issue of Clinics in Liver Disease, 1st Edition</strong></p>
<p>In this issue of <em>Clinics in Liver Disease</em>, guest editor Robert G. Gish brings his considerable expertise to the topic of <strong>Hepatitis B and Hepatitis D</strong>. The articles provide state-of-the-art clinical summaries of the advances in Hepatitis B and D, with emphasis on HBV viro-immunology, novel assays, new targets, and tests for HBV and HDV, and more. </p>
<p><strong>Key Features <br />Contains 13 relevant, practice-oriented topics</strong> including Novel Assays to Solve the Clinical and Scientific Challenges of Chronic Hepatitis B; Maternal-to-Child Transmission of Hepatitis B Virus and Hepatitis Delta Virus; Triple Threat: HDV, HBV, HIV Coinfection; Targeting Hepatitis B Virus DNA Using Designer Gene Editors; and more. </p>
<p><strong>Provides in-depth clinical reviews on Hepatitis B and D</strong>, offering actionable insights for clinical practice. </p>
<p><strong>Presents the latest information on this timely, focused topic</strong> under the leadership of experienced editors in the field. Authors synthesize and distill the latest research and practice guidelines to create clinically significant, topic-based reviews. </p>
<p><a href="https://www.us.elsevierhealth.com/advances-in-viral-hepatitis-b-and-d-moving-toward-the-goals-of-elimination-an-issue-of-clinics-in-liver-disease-9780323939478.html" target="_blank" rel="noopener">Buy Book</a></p>Hepatitis delta virus infection in patients with hepatitis b in the united states2023-11-18T10:00:00+00:002023-11-18T10:00:00+00:00https://www.robertgish.com/blog/hepatitis-delta-virus-infection-in-patients-with-hepatitis-b-in-the-united-states<p><img src="/uploads/screenshot-2023-11-22-at-9-41-51-am.png" alt="" width="784" height="296" /></p>
<p><strong>Prevalence and characteristics of Hepatitis delta virus infection in patients with hepatitis b in the united states: An analysis of the All-Payer Claims Database</strong></p>
<p><em>Background and Aims:</em> <br />Hepatitis delta virus (HDV) leads to the most severe form of viral hepatitis; however, the prevalence of HDV is not well understood. Using real-world data from the All-Payer Claims Database (APCD), this study estimates the prevalence of HBV/HDV infection among the chronic hepatitis B (HBV) population and describes patient/clinical characteristics for adults with HBV/HDV infection in the United States (US).</p>
<p><a href="https://journals.lww.com/hep/abstract/9900/prevalence_and_characteristics_of_hepatitis_delta.652.aspx" target="_blank" rel="noopener">Read Article</a></p>The Epidemiology of Hepatitis B Virus2023-10-31T10:00:00+00:002023-10-31T10:00:00+00:00https://www.robertgish.com/blog/the-epidemiology-of-hepatitis-b-virus<p><img src="/uploads/screenshot-2023-10-31-at-10-10-27-am.png" alt="" width="860" height="700" /></p>
<p><strong>The Epidemiology, Transmission, Genotypes, Replication, Serologic and Nucleic Acid Testing, Immunotolerance, and Reactivation of Hepatitis B Virus</strong></p>
<p>ABSTRACT<br />The epidemiology of HBV has drastically changed in recent decades due to public health initiatives, including universal infant vaccination programs and urbanization driving global travel and migration patterns. Despite screening of pregnant women and newborns significantly reducing the rate of perinatal transmission in certain parts of the world, other, perhaps more uncommon, routes (eg, parenteral) have led to outbreaks in specific areas affected by the opioid epidemic and injection drug use. Although our current understanding on the effect of genetic variants of HBV is lacking, we review current knowledge and patterns of genetic variants with geographical predominance, pathophysiology, and clinical manifestations. Serologic and molecular markers are used to screen, identify phase and activity of infection, and monitor response to antivirals and/or reactivation. This review will provide the most up-to-date summary of the epidemiology, transmission, genotype, replication, and current methods of screening to follow the various phases of HBV, including immunotolerance and reactivation.</p>
<p><a href="https://jumpshare.com/v/BSXeP6Hi8fMFhTqi78Yn" target="_blank" rel="noopener">Read Article</a></p>Disease Progression Among Commercially Insured HDV Infected Patients in the US2023-10-20T10:00:00+00:002023-10-20T10:00:00+00:00https://www.robertgish.com/blog/disease-progression-among-commercially-insured-hdv-infected-patients-in-the-us<p><img src="/uploads/screenshot-2023-10-21-at-3-20-05-pm-1.png" alt="" width="796" height="473" /></p>
<p><strong>Disease Progression Among Commercially Insured Hepatitis Delta Virus Infected Patients in the United States</strong></p>
<ul>
<li>HDV patients had a significantly higher rate of severe liver disease progression as compared to HBV monoinfected patients</li>
<li>HDV patients had a 54%, 60%, and 62% higher risk of progression from noncirrhotic disease to CC, DCC, and HCC, respectively, than HBV monoinfected patients</li>
</ul>
<p><a href="https://jumpshare.com/v/WqiDWcEtnlq2U5elcEjM" target="_blank" rel="noopener">Download PowerPoint</a></p>