Authors (including presenting author) :
Ma ACK (1), Lui NS (1), Leung L (2), Chan TT (1), Mak KW (1), Ho CY (1)
Affiliation :
(1) Division of Gastroenterology and Hepatology, Department of Medicine and Therapeutics,
(2) Department of Oncology
Introduction :
With the tragic medical incident related to HBV reactivation in 2017, the safety issue related to antivirals for HBV is still a big concern.
Patients prescribed with high dose steroids, immunosuppressants, systematic chemotherapy or B cell depleting therapies are tested for HBsAg,anti anti-HBc total in the Department of Clinical Oncology. If positive, these patients are initiated on antiviral therapy as prophylaxis for HBV re-activation.
After chemotherapy, and if the patients are deemed to be in remission they theoretically no longer require life-long antivirals. However, HBV reactivation is possible after the cessation of antivirals.
Objectives :
Close monitoring of blood tests to look for virological +/- biochemical breakthough after the cessation of antivirals can ensure the safety of this group of patients.
Methodology :
With the referral from other departments (Department of Clinical Oncology mainly), Hepatologists will arrange a follow up to see the patients for discussion on antiviral cessation.
Hepatologists and hepatology nurses will ensure that the patients are well-informed with regard to the plan of antiviral cessation and follow a protocol driven pathway. They will arrange follow-up sessions:
1. Monitor liver function tests +/- HBV DNA at month 0, 1, 3, 6, 12, 18
2. Nurse led clinics at month 6 and 12
3. Perform transient elastography of the liver to detect any fibrosis
4. Educate the patients to avoid hepatotoxic agents in the future.
The nurse specialists will refer the case back to Hepatologists in case of flare up or other abnormalities.
Result & Outcome :
With this well-designed pathway, it ensures safe cessation of antivirals and close-monitoring of virological +/- biochemical breakthrough. The nurse clinic helps shorten the waiting time and reduces the number of attendances required by the Hepatology clinic to increase the quality of care and the capacity of the clinics to receive new case referrals from the Department of Clinical Oncology.
During the pilot phase in the last year, there were 14 patients enrolled into this pathway.
They were treated with either systemic chemotherapy, or B cell depleting agents. No flares have been detected so far. No significant fibrosis or cirrhosis was noted in patients who had transient elastography performed.
