CCO Annual Update
Hepatitis Annual Update 2003
Natural History of Hepatitis C
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Module 1 of 12
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Program Director:
John P. Phair, MD
- Adrian M. Di Bisceglie, MD, FACP
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 Topics covered include:
- Introduction
- Persistence of HCV Infection
- Progression of Hepatic Fibrosis and Cirrhosis
- Development of Liver Failure and Hepatocellular Carcinoma
- Impact of Antiviral Therapy on the Natural History of Chronic Hepatitis C
Learning Objectives
Upon completion of this activity, participants should be able to:
Identify viral and host factors that influence progression of HCV infection Describe the natural progression from acute infection with HCV to chronic liver disease and hepatocellular carcinoma Discuss potentially modifiable risk factors for HCV progression in advising patients about prognosis
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Immunopathogenesis of Fibrosis and Relevance to Therapeutic Targets
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Module 2 of 12
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Program Director:
John P. Phair, MD
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Topics covered include:
- Introduction
- Diagnosis of Hepatic Fibrosis and Cirrhosis in Chronic Hepatitis C
- Diagnosis (cont'd)
- Natural History and Risk Factors of Fibrosis in HCV
- Fibrosis Progression in Other Liver Diseases
Learning Objectives
Upon completion of this activity, participants should be able to:
Detail the development of fibrosis and the role of the immune system Review the relevance of fibrosis to therapeutic targets Discuss whether fibrosis is reversible
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Treatment of Hepatitis C: The State of the Art
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Module 3 of 12
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Program Director:
John P. Phair, MD
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Topics covered include:
- Introduction
- Background: Treatment of Hepatitis C Since 1990
- Pegylated Interferons
- Peginterferon Plus Ribavirin
- Considerations in Patient Selection
Learning Objectives
Upon completion of this activity, participants should be able to:
Review the clinical value of sustained virologic response to antiviral therapy Discuss data that support decision-making, including early virologic response, and responses at 24 vs 48 weeks Describe the comparative efficacy of available treatment regimens
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Re-Treatment of Hepatitis C in Nonresponders/Relapsers
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Module 4 of 12
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Program Director:
John P. Phair, MD
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Topics covered include:
- Introduction
- Definitions
- Re-treatment of Patients with Chronic Hepatitis C
- Factors that Affect Response to Re-treatment
- Approach to the Patient with Continued Nonresponse
Learning Objectives
Upon completion of this activity, participants should be able to:
Enumerate options available for patients with chronic hepatitis C who have failed to achieve a sustained virologic response following re-treatment with peginterferon and ribavirin. Describe the criteria of nonresponse and relapse to interferon therapy in patients with chronic hepatitis C. Review the results of studies in which patients with chronic hepatitis C with nonresponse or relapse have been re-treated with peginterferon and ribavirin. Discuss factors associated with successful re-treatment of nonresponders and relapsers.
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HCV/HIV Coinfection
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Module 5 of 12
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Program Director:
John P. Phair, MD
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Topics covered include:
- Epidemiology
- Diagnosis of HCV Infection in HIV-Seropositive Individuals
- Pathogenic Interactions
- Natural History of HCV and HIV
- Natural History of HCV and HIV (cont'd)
Learning Objectives
Upon completion of this activity, participants should be able to:
Describe how HIV infection modifies the diagnosis and natural history of HCV. Review special issues that arise in the treatment of HCV in HIV-infected persons, including drug interactions and comorbidities. Discuss the optimal treatment of HCV in HIV-coinfected persons.
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Managing Psychiatric Side Effects of Interferon
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Module 6 of 12
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Program Director:
John P. Phair, MD
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Topics covered include:
- Introduction
- Symptoms and Risk Factors
- Symptoms and Risk Factors (cont'd)
- Treatment of Depression Induced by IFN-alfa
- Factors to Consider in Selecting an Antidepressant
Learning Objectives
Upon completion of this activity, participants should be able to:
List significant neuropsychiatric side effects and differentiate the spectrum of disorders to select appropriate therapy Discuss which psychiatric disorders are contraindications for the treatment of chronic viral hepatitis Review the potential hepatotoxic and addictive complications of the drugs available to treat depression and anxiety
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Managing the Hematologic Complications of Interferon/Ribavirin
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Module 7 of 12
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Program Director:
John P. Phair, MD
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Topics covered include:
- Introduction
- Anemia Associated with Peginterferon/Ribavirin Therapy
- Mechanisms of Ribavirin-Associated Anemia
- Interferon-Associated Bone Marrow Suppression, with or without Ribavirin
- Management of Anemia During Interferon/Ribavirin Therapy
Learning Objectives
Upon completion of this activity, participants should be able to:
Review the mechanism of treatment-related cytopenias Discuss the role of growth factors in the management of treatment-related cytopenias Describe approaches to the management of treatment-related cytopenias
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HCV Life Cycle and Targets for Drug Development
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Module 8 of 12
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Program Director:
John P. Phair, MD
- Charles M. Rice, III, PhD
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Topics covered include:
- Introduction
- The HCV Life Cycle
- Entry Into Host Cells
- Translation of the HCV Genome and Polyprotein Processing
- RNA Replication Process
Learning Objectives
Upon completion of this activity, participants should be able to:
Review the current HCV drug discovery process, including limitations with current biochemical and cell-based assays and animal models Describe the steps in HCV replication, including entry, RNA replication, and release of new virus In the context of the HCV life cycle, evaluate the most likely targets for new drug development, including the pros and cons of protease, helicase, and polymerase inhibitors
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Novel Therapies and Therapeutic Strategies for HCV
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Module 9 of 12
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Program Director:
John P. Phair, MD
- John G. McHutchison, MD, FRACP
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Topics covered include:
- Introduction
- Derivatives of Currently Licensed Therapies
- Enhancing Currently Licensed Therapies
- Immune-Based Therapies & Therapeutic HCV Vaccines
- Targeted Therapy
Learning Objectives
Upon completion of this activity, participants should be able to:
Discuss likely novel treatments for hepatitis C Understand the life cycle of HCV and the steps amenable to intervention Review forthcoming revisions in existing treatments for hepatitis C
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Treatment of Hepatitis B: The State of the Art
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Module 10 of 12
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Program Director:
John P. Phair, MD
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Topics covered include:
- Introduction
- Goals of Therapy
- Evaluation and Selection of Patients for Therapy
- FDA-Approved Therapies for Treating Hepatitis B
- Treatment of HBeAg-Positive Patients
Learning Objectives
Upon completion of this activity, participants should be able to:
List the pros and cons of available therapies Recognize the indications for antiviral therapy for chronic hepatitis B Describe the approach to monitoring and the clinical end point goals during therapy
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Novel Therapies and Therapeutic Strategies for HBV
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Module 11 of 12
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Program Director:
John P. Phair, MD
- John G. McHutchison, MD, FRACP
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Topics covered include:
- Introduction
- Nucleoside and Nucleotide Analogue Polymerase Inhibitors
- Nucleoside and Nucleotide Analogue Polymerase Inhibitors (cont'd)
- Nucleoside and Nucleotide Analogue Polymerase Inhibitors (cont'd)
- Other Categories
Learning Objectives
Upon completion of this activity, participants should be able to:
Review the rationale for combination therapy for HBV Discuss likely strategies for new drug development Describe new compounds for the treatment of hepatitis B
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The Identification of HCV and Eradication of Posttransfusion Hepatitis
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Module 12 of 12
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Program Director:
John P. Phair, MD
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Topics covered include:
- Introduction
- The Discovery of HCV: A Historical Perspective
- Non-A, Non-B Hepatitis
- The Incidence, Impact, and Decline of Transfusion-Associated Hepatitis
- The Impact of Donor Screening for HCV Infection
Learning Objectives
Upon completion of this activity, participants should be able to:
- Describe the history of research programs that led to the discovery of the hepatitis C virus (HCV)
- Review sequential donor screening measures that have led to the near eradication of posttransfusion hepatitis
- Identify the specific impact of HCV screening on the eradication of transfusion-transmitted hepatitis C
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Animations
Sinusoidal Changes in Liver Fibrogenesis
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