I am a passionate, outgoing, dedicated and research-driven second year medical student at Stanford School of Medicine. I aspire to become an exceptional physician and desire to address the social determinants of health in my daily work. I am also interested in the realms of social media marketing, graphic design, business, and the intersection of app/social media development.
Liver complications in untreated treatment-ineligible versus treated treatment-eligible patients with hepatitis B.
Digestive diseases (Basel, Switzerland)
A substantial number of patients who do not meet treatment criteria for chronic hepatitis B later develop adverse outcomes such as cirrhosis and hepatocellular carcinoma (HCC). Our aim was to determine whether current practice guidelines adequately identify chronic hepatitis B (CHB) patients who will benefit from antiviral therapy.We performed a retrospective cohort study comparing the incidence of adverse liver outcomes (cirrhosis and/or HCC) in untreated treatment-ineligible (at baseline and throughout follow-up) versus treated treatment-eligible patients according to standard AASLD 2018 guidance (ALT [U/L] > 70/50 for men/women plus HBV DNA [IU/mL] > 20,000/2,000 for HBeAg+/-) and with a sensitivity analyses using a lower threshold (ALT > 40 U/L and HBV DNA > 2,000 IU/mL).We reviewed records of 5,840 patients from 5 clinics in California and identified 2,987 treatment-naïve non-HCC CHB patients. Of those, 271 patients remained untreated treatment-ineligible, 514 patients were treatment-eligible and initiated treatment, with 5-year cumulative adverse liver incidences of 12.5% vs 7.2%, P=0.074. On multivariable analysis adjusting for age, sex, diabetes, albumin, platelet count and HBV DNA, compared to treated treatment-eligible patients, untreated treatment-ineligible patients had a significantly higher risk of adverse liver outcomes (adjusted HR: 2.38, 95% CI 1.03-5.48, P=0.04) in main analysis by AASLD 2018 criteria, but not in sensitivity analysis using the lower treatment threshold (P=0.09).Patients never meeting standard AASLD 2018 criteria for antiviral therapy and never treated had twice the risk of developing cirrhosis and/or HCC when compared to eligible and treated patients.
View details for DOI 10.1159/000526933
View details for PubMedID 36070707
LIVER COMPLICATIONS IN UNTREATED TREATMENT-INELIGIBLE VERSUS TREATED TREATENT-ELIGIBLE PATIENTS WITH HEPATITIS B
View details for DOI 10.1016/S0016-5085(21)02606-8
Hepatitis B and renal function: A matched study comparing non-hepatitis B, untreated, treated and cirrhotic hepatitis patients
2019; 39 (4): 655–66
View details for DOI 10.1111/liv.14009
View details for Web of Science ID 000462572800010
Poor Adherence to Guidelines for Treatment of Chronic Hepatitis B Virus Infection at Primary Care and Referral Practices
CLINICAL GASTROENTEROLOGY AND HEPATOLOGY
2019; 17 (5): 957-+
View details for DOI 10.1016/j.cgh.2018.10.012
View details for Web of Science ID 000461795700030
Poor Adherence to Guidelines for Treatment of Chronic HBV Infection at Primary Care and Referral Practices.
Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association
The American Association for the Study of Liver Diseases (AASLD) guidelines for treatment of chronic hepatitis B virus (HBV) infection have changed with time. We assessed rates of treatment evaluation and initiation in patients with chronic HBV infection from different practice settings in the past 14 years.Treatment-naïve patients with chronic HBV infection were recruited from different practice settings in California from January 2002 through December 2016. The study population comprised 4130 consecutive, treatment-naïve patients with chronic HBV infection seen by community primary care physicians (n=616), community gastroenterologists (n=2251), or university hepatologists (n=1263). Treatment eligibility was assessed using data from the first 6 months after initial presentation based on AASLD criteria adjusted for changes over time.Within the first 6 months of care, the proportions of patients evaluated by all 3 relevant tests (measurements of alanine aminotransferase, hepatitis B virus e-antigen, and HBV DNA) were: 36.69% of in community primary care, 59.80% in gastroenterologist care, and 79.97% in the hepatology care (P<.0001 among the three groups). Higher proportions of patients were eligible for treatment in specialty practices: 12.76% in community primary care, 24.96% in gastroenterologist care, and 29.43% in hepatology care (P<.0001). Among treatment-eligible patients, there was no significant difference in the proportions of patients who began antiviral therapy between those receiving treatment from a gastroenterologist (55.65%) vs a hepatologist (57.90%; P=.56). Of 243 evaluable patients receiving community primary care, only 31 were eligible for treatment and only 12 of these (38.71%) received treatment.In an analysis of patients receiving care for chronic HBV infection, we found the proportions evaluated and receiving treatment to be suboptimal, according to AASLD criteria, in all practice settings. However, rates of evaluation and treatment were lowest for patients receiving community primary care.
View details for PubMedID 30326298
Hepatitis B and Renal Function: A Matched Study Comparing Non-Hepatitis B, Untreated, Treated and Cirrhotic Hepatitis Patients.
Liver international : official journal of the International Association for the Study of the Liver
Renal impairment is associated with chronic hepatitis B (CHB). To overcome prior study design differences, we used propensity score matching to balance the non- CHB and CHB cohorts and generalized linear modeling (GLM, models using probit and logit linking functions for complex models) to evaluate the effect of CHB, treatment, and cirrhosis on renal function.A retrospective cohort (1996-2017) from one U.S. university medical center. Included patients had ≥12 months of serial creatinine labs and a baseline estimated glomerular filtration rate (eGFR, by the Modification of Diet in Renal Disease Study equation) ≥60 mL/min/1.73 m2 . Propensity score matching was performed using age, sex, ethnicity, diabetes, hypertension, and baseline eGFR. GLM was performed to generate adjusted mean eGFR over time.Adjusted mean eGFR was significantly higher for non-CHB vs. untreated CHB patients (eGFR 87.4 vs. 85.6, p=0.004, n=580, median follow-up=82 months). A significant difference in adjusted mean eGFR between untreated vs. entecavir (ETV)-treated CHB patients (eGFR 85.1 vs. 83.5, p=0.02, n=340, median follow-up=70 months) was found among non-cirrhotic CHB. Among treated CHB, there was no difference in adjusted mean eGFR between non-cirrhotic vs. cirrhotic patients (eGFR 77.0 vs. 76.5; p=0.66, n=112, median follow-up=58 months).After PSM and GLM, the significant predictors for worsening renal function were age, hypertension, and diabetes mellitus but not CHB, ETV, or cirrhosis. However, given small sample size, data regarding the use of ETV in patients with cirrhosis should be interpreted with caution and requires additional investigation. This article is protected by copyright. All rights reserved.
View details for PubMedID 30460749