HBV Treatment Controversies in 2009:

A DebatePresented by The Johns Hopkins University School of Medicine

Produced in collaboration with ViralEd LLC

Welcome and Introduction

Moderator: Albert Min MD

Discussants: Mark Sulkowski MD

Douglas Dieterich MD

Accreditation Statement

The Johns Hopkins University School of Medicine is accredited by the Accreditation Council for

Continuing Medical Education to provide continuing medical education for physicians.

Credit Designation Statement:The Johns Hopkins University School of Medicine designates this

educational activity for a maximum of 2.0 AMA PRA Category 1 Credits™. Physicians should only claim credit commensurate with the

extent of their participation in the activity.

To obtain CME credit, go to the heading “Instructions forObtaining Continuing Medical Education Credit” on the home

page of this program and click on the “CME Post Test andEvaluation” link.

This program is made possible through an

educational grant from Gilead Sciences

Program Objectives

At the conclusion of this activity the participant should be able to:

1. Summarize, discuss with colleagues, and apply clinically the most recent and relevant data on the diagnosis, management and treatment of CHB including the use of new diagnostic and monitoring tools and recently approved therapies;

2. Assess CHB patients and make an appropriate clinical decision regarding the role of and need for liver biopsy;

3. Review patient case scenarios and be able to outline and discuss the factors to consider when deciding on when to start CHB therapy;

4. Be aware of and knowledgeable about the risks and benefits of various CHB therapies currently available;

5. Assess and explain the potential role of combination therapy in treatment-naïve and treatment-experienced patients; and

6. Evaluate the potential role for HBV resistance testing and the potential for resistance associated with various CHB treatment strategies in the context of clinical case scenarios.

Course Directors

Douglas T. Dieterich, MDProfessor of Medicine and Director of CME,

Department of Medicine, Director of Outpatient Hepatology,

Division of Liver Diseases,

Mount Sinai School of Medicine

Mark Sulkowski, MDAssociate Professor of Medicine and Medical Director,

Viral Hepatitis Center,

Johns Hopkins University School of Medicine

Faculty

Nezam H. Afdhal, MDBeth Israel DeaconnessMedical CenterHarvard Medical School

Robert S. Brown, Jr., MD, MPHColumbia UniversityMedical Center

Steven L. Flamm, MDNorthwestern FeinbergSchool of Medicine

Ira Jacobson, MDNewYork-Presbyterian HospitalWeill Cornell Medical College

Paul Kwo, MDIndiana UniversitySchool of Medicine

Paul Martin, MD, FACPUniversity of MiamiMiller School of Medicine

Fred Poordad, MDCedars-Sinai Medical CenterDavid GeffenSchool of Medicine at UCLA

Tram T. Tran, MDCedars Sinai Medical CenterDavid Geffen School of Medicine at UCLA

Naoky Tsai, MDJohn A. BurnsSchool of MedicineUniversity of Hawaii

Disclosures

As a provider accredited by the Accreditation Council for Continuing Medical Education (ACCME), it is the

policy of the Johns Hopkins University School of Medicine to require the disclosure of the existence of

any significant financial interest or any other relationship a faculty member or a sponsor has with the manufacturers of any commercial products discussed in an educational presentation. The disclosures of the faculty for this program can be found in your handout materials and are presented in the following slides:

DisclosuresMark Sulkowski, MD

– Sources of Funding for Research: Roche, Schering-Plough, Vertex, Human Genome Sciences, Boehringer-Ingelheim, Merck, Idenix, Valeant, Mederax, Tibotec, Gilead Sciences.

– Consultant: Roche, Schering, Vertex, HGS, Boehringer-Ingelheim, Tibotec, Bristol Myers Squibb

Douglas Dieterich, MD– Grant Research: Boehringer-Ingelheim, Gilead Sciences

– Consulting Agreements: Roche, Tibotec, BMS, Gilead Sciences, Boehringer-Ingelheim

– Speakers' Bureau/Honorarium Agreements: Roche, Tibotec, BMS, Gilead Sciences, Boehringer-Ingelheim, GlaxoSmithKline

Albert Min, MD– Grant Research/Consultant/Honorarium/Speaker Bureau:

Bristol Myers Squibb, Gilead Sciences

This presentation includes information on studies and data presented off-label uses of entecavir, tenofovir, adefovir, interferon, lamivudine

The Johns Hopkins University School of Medicine

takes responsibility for the content, quality, and

scientific integrity of this CME activity.

Debate Topics

1. When to Start: Patient with “normal” ALT

2. What to Start: Treatment naïve – PegIFN or nucleos(t)ide analogues

3. What to Start: Patient with Possible Prior Lamivudine Exposure

4. When to Add or Modify Therapy in Setting of Incomplete Viral Suppression