Hepatitis C virus (HCV) infection is a devastating disease that is increasingly being diagnosed among Filipinos, especially in at-risk populations. There are disease-specific nuances in the evaluation and management of this infection. Furthermore, advances in the field brought about by clinical research are rapidly moulding the way we evaluate and manage HCV patients. Evidently, consensus statements formulated by experts in the field are needed in order to serve as a guide to physicians who see HCV patients in the clinic. With this in mind, the Hepatology Society of the Philippines spearheaded the formation of these statements which aimed to address issues in the diagnosis, evaluation, treatment, and follow-up care of patients with HCV infection.
Recommendations on the specific tests to perform in the evaluation of HCV patients before, during and after treatment, and first-line treatment of patients with acute and chronic HCV infection were provided. Treatment algorithms for chronic HCV infection, divided according to viral genotype, were also devised. We acknowledge the limitations brought about by the local inavailability of some drugs/treatment regimens in the local setting at the time of the formulation of these statements. As such, these statements will be revised as soon as new data become locally applicable.

 

Hepatitis C ; Diagnosis ; Infection ; Consensus ; Carcinoma, Hepatocellular ; Liver Cirrhosis

Chorinic hepatitis B virus (CHB) infection is a serious problem that affects over 300 million people worldwide and is highly prevalent in the Asia Pacific region. In the Philippines an estimate 7.3 million Filipinos or 16.7% of adults are chronically infected with HBV, more than twice the average prevalence in the Western Pacific region.

In view of the above, the Hepatology Society of the Philippines (HSP) embarked on the development of consensus statements on the management of hepatitis B with the primary objectives of standardizing approach to management, empowering other physicians involved in the management of hepatitis B and advancing treatment subsidy by the Philippine Health Insurance Corporation (PhilHealth).

The local guidelines include screening and vaccination general management, indications for assessment of fibrosis in those who did not meet treatment criteria. indications for treatment, on-treatment and post-treatment monitoring and duration of antiviral treatment. Recommendations on the management of antiviral drug resistance, management of special populations including patients with concurrent HIV or hepatitis C infection, women of child-bearing age (pregnancy and breastfeeding), patients with decompensated liver disease, patients receiving immunosuppressive medications or chemotherapy and patients in the setting of hepatocellular carcinoma are also included. However, the guidelines did not include management for patients with liver and other solid organ transplantation, patients on renal replacement therapy, and children.

The consensus statements will be amended accordingly as new therapies become available.

Hepatitis B ; Consensus ; Hepatitis B, Chronic ; Hepatitis B Virus ; Fibrosis ; Drug Therapy ; Carcinoma, Hepatocellular ; Liver Cirrhosis ; Hepatitis Delta Virus ; Hiv

Background : Quality of life (QoL) is arguably as important as the survival rate in patients with hepatocellular carcinoma (HCC). However, very few studies have evaluated the factors that determine good or poor QoL in patients with HCC.Objectives:To correlate baseline QoL (EORTC-QLQC30) with baseline laboratory and clinical parameters among HCC patients.Patients and Method: Thirty nine consecutive newly-diagnosed HCC patients were recruited, Spearman;s rank correlation was used to correlate the QoL scores, which consisted of 15 domians, wirg continous baseline variables while the Mann-Whitney U or kruskal Wallis tests were used for categorial variables.Results: The mean age of the cohort was 61.3 +- 14.5, majority of whom were male(89.7). Majority had childs Pugh Turcott (CPT) score af A (61.5%) and barcelona Clinic Liver cancer (BCLC) stage A-B (76.9%). A third (33.3%) knew of their diagnosis at the time of QoL between the 2 groups (p>0.05). There was no consistent pattern in the correlation between laboratory parameters with QoL, with some running contrary to conventional reasoning (Higher international normalized ratio correlation with better role function[p=0.02] and less pain [0.035]; CPT score A associated with lower global health status compared to CPT B/C [p=0.028]). On the other hand, BCLC staging was a more sensible relection of QoL with BCLC A/B patients having higher physical (p=0.014) and social (p=0.049) function, and lower symptom scores for nausses/vomiting (p=0.041) and dyspnea (p=0.004) than patients with BCLC C/D.Conclusion: baseline EORTC-QLC-C30 of patients with HCC has no consistent correlation with the severity of liver dysfunction. Correlation of some domains of the EORTC-QLQ-C30 with BCLC staging suggests that umor burden is the main determinant of QoL in HCC patients. Further studies are needed to determine whether baseline QoL predicts survival independent of HCC staging.
Hepatocellular Carcinoma