AHF 2019: Pre-Activity Survey

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* 1. What degree best describes you? I am a:

PhD

PharmD

Other (please specify)

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* 2. How many patients do you currently see each week?

Less than 5

5-15

16-25

26-35

36-45

46-55

56 or more

I do not directly provide care

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* 3. According to the most recent WHO data, which of the following countries has the lowest prevalence (i.e., <2% of population) of HBsAg+?

China

India

South Korea

United States

Vietnam

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* 4. According to studies on the natural history of HBV, what percent of chronic HBV-infected individuals would develop hepatocellular carcinoma without underlying cirrhosis?

0 - 5%

5 - 10%

10 - 20%

20 - 25%

30 - 40%

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* 5. What viral load cutoff is recommended by various practice guidelines and algorithms for considering antiviral therapy in HBeAg-negative chronic hepatitis B patients without cirrhosis?

Any detectable HBV DNA level

1,000 IU/mL

2,000 IU/mL

20,000 IU/mL

200,000 IU/mL

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* 6. Which of the following statement regarding HBV comorbidity is correct?

Traditional focus of HBV management remains on antiviral therapy

Comorbid conditions are common and increasing in prevalence among CHB patients

Presence of comorbid conditions among CHB patients is under-recognized

Aggressive identification and management of comorbidities among CHB patients may improve clinical outcomes

All of the above

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* 7. Which of the following statements is not true regarding a retrospective observational study of comorbidities in insured CHB patients in the U.S. from 2006 to 2015?

There was a trend for aging cohort of patients with CHB from 2006 to 2015

Incidence of CKD has increased over time in the CHB patients regardless of type of insurance coverage

Prevalence of CKD has increased over time in the CHB patients regardless of type of insurance coverage

Incidence of bone disease (osteoporosis/bone fractures) has increased over time in the CHB patients regardless of type of insurance coverage

Prevalence of bone disease (osteoporosis/bone fractures) has increased over time in the CHB patients regardless of type of insurance coverage

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* 8. Case-Based Question

You evaluate a 57-year-old Asian man with HBeAg-negative CHB as a new patient to establish care. He has recently relocated to your area for his new job. He has been on antiviral therapy for almost
10 years.
•        Medication: tenofovir disoproxil fumarate (TDF)
•        His exam is unremarkable
•        His ALT is 30, AST 26, platelet 210,000, TB 0.8 mg/dl, Creatinine 0.9 mg/dL, Hgb 14.5 g/dL

According to a retrospective observational U.S. study of comorbidities in insured CHB patients from 2006 to 2015, which one of the following comorbidities is most likely present in this CHB patient?

Cardiovascular disease

Diabetes

Hyperlipidemia

Hypertension

Renal impairment

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* 9. Which of the following comorbid conditions among CHB patients should one consider for active identification and management?

Co-infections

Metabolic syndrome

Alcohol/tobacco use disorder

Renal disease

All of the above

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* 10. Which of the following statements regarding HBV and HIV co-infection is not true?

Among patients with HIV, about 70% have prior or active HBV infection (HBcAb+)

Among HIV patients, about 7-10% have co-infection with HBV (HBV DNA+)

Among CHB patients, 2% have HIV co-infection.

For patients with HBV/HIV co-infection, one should start antiretroviral therapy (ART) when CD4 count is >200 with dual anti-HBV activity.

CHB patients with HIV co-infection are at a higher risk for cirrhosis, HCC and mortality when compared to CHB patients without HIV co-infection.

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* 11. Which of the following statements regarding HBV and HCV co-infection is true?

Among patients with HCV, about 35% have prior or active HBV infection (HBcAb+)

Among HCV patients, 1-2% have co-infection with HBV (HBV DNA+)

In HBV/HCV co-infection, one virus usually dominates-usually HCV

There is 30-50% chance for risk of HBV reactivation if HBsAg+ with HCV DAA therapy

All of the above

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* 12. All of the following statements regarding HBV and HDV co-infection are true except:

Among patients with HBV, 3-5% have HDV co-infection

HDV infection is endemic to Mediterranean, Middle East, and Southeast Asia

Among CHB patients, HDV co-infection is associated with higher risk of cirrhosis, decompensation, HCC and mortality

One should screen all at-risk HBsAg+ patients for HDV with anti-HDV (HDV Ab)

All HDV Ab+ patients should undergo confirmation with HDV RNA testing

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* 13. Which of the following is not associated with increased risk of HCC in CHB patients?

Alcohol use

Tobacco use

Metformin use

Co-infections (HCV, HDV or HIV)

Metabolic syndrome