Hepatitis B Case for Discussion at Project ECHO meeting Liverpool Hospital
If you need to discuss a case prior to the Project ECHO meeting call Quyen Trinh (Admin) on 
02 8738 4074 or Melissa Bagatella (CNC) on 8738 3571 or 0408 968 191
PLEASE SEND THIS REFERRAL TO FAX: 02 8738 3094 or EMAIL: 
SWSLHD-LiverpoolGastro@health.nsw.gov.au
Referring Dr		
Patient name and DOB:		
Gender:		
Date:		
•	Year CHB Diagnosed if known
•	Country of Birth
•	Family history HBV or liver cancer
•	Indigenous yes /no
•	Other possible transmission risk: 
Medical history:	Allergies:

	Current medications:	

Liver health assessment:
Chronic Hepatitis B/other viral hepatitis	Baseline blood tests date:	
HBsAg	+	-	HBeAg	 +	-	HCV Ab	 +	-	HCV RNA	 +	-	
HBcAb	+	-	HBeAb	 +	-	Hepatitis D (Delta) antibody	 +	-	
Details of previous antiviral therapy: 	
Imaging / Elastrography (Fibroscan) date: 	
Metabolic liver disease risks	DM2	Y	N	 HbA1c:	
Overweight/obese	Height	cm	Weight	kg	BMI		
Substance use issues	Smoking pack years:	
Alcohol daily standard units (average):	Other (IDU, other illicit):	

Symptoms / signs of CLD:	

	

Dynamic Investigations/monitoring (reuse same form in future discussions)	
Date	ALT	HBeAg/eAb	HBV DNA *	HBV Treatment (nil or name it)	APRI or Fibroscan 	HCC Surveillance
(Modality US/CT/MRI)
Lesions? Cirrhosis?	

							

							

							

* HBV DNA is only funded once a year if patient is not on antiviral therapy. 
Routine 6 monthly HCC surveillance indicated for Asian women >50, men >40, Africans over 20 years, cirrhotics or family history of liver cancer

Comments

  

ECHO MEETING ADVICE:	

	

Checklist for discussion with patient: 

☐ Natural history of 
      HBV	☐ Transmission and 
      prevention 	☐ Self-management 
     advice	
☐ Treatment options	☐  The importance of 
      adherence	☐ Treatment may be 
      lifelong	
☐ Importance of 
     regular monitoring	☐ Testing and vaccination of
    household/family contacts	☐ Provided written 
      info / resource list	

PHASES OF CHRONIC HEPATITIS B:
Phase	HBV DNA
(IU/mL)	HbeAg	HbeAb	        ALT	         Management	
Tolerant
(HBeAg pos infection)	>20 000	+	-	Normal	Monitor	
Clearance
(Hepatitis)	>20 000 	+	-	        Raised	Consider Rx
	
Control
(HBeAg neg infection)	<2000
	-	+	        Normal	Monitor	
Escape
(Hepatitis)	>2000	-	+	        Raised	Consider Rx

NON-INVASIVE FIBROSIS TESTING:

Non-invasive fibrosis estimation is recommended in all cases to assess for signs of advanced fibrosis or cirrhosis http://www.hepatitisc.uw.edu/page/clinical-calculators/apri	
APRI	FIB4	FIBROSCAN		
Use AST and platelets,
<1 negative predictive value 93%  for cirrhosis
 > 1 proceed to fibroscan
	<1.45   negative predictive value 90% for adv fibrosis/cirrhosis	<5	No/minimal fibrosis	
		5-6	Low probability of significant fibrosis	
		>6-9	Difficult to interpret	
		>9-12	Significant fibrosis	
		>12	Possible cirrhosis