Hepatitis B Questions & Answers

1. Centers for Disease Control and Prevention. Hepatitis B information for health professionals: hepatitis B FAQs for health professionals. http://www.cdc.gov/hepatitis/HBV/index.htm. Available at http://www.cdc.gov/hepatitis/HBV/index.htm. Updated May 31, 2015; Accessed: May 23, 2017.

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4. World Health Organization. Hepatitis B. July 27, 2021. Available at https://www.who.int/news-room/fact-sheets/detail/hepatitis-b. Accessed: December 2, 2021.

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7. Fattovich G, Giustina G, Schalm SW, et al. Occurrence of hepatocellular carcinoma and decompensation in western European patients with cirrhosis type B. The EUROHEP Study Group on Hepatitis B Virus and Cirrhosis. Hepatology. 1995 Jan. 21(1):77-82. [QxMD MEDLINE Link].

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16. Davies SE, Portmann BC, O'Grady JG, et al. Hepatic histological findings after transplantation for chronic hepatitis B virus infection, including a unique pattern of fibrosing cholestatic hepatitis. Hepatology. 1991 Jan. 13(1):150-7. [QxMD MEDLINE Link].

17. Kahila Bar-Gal G, Kim MJ, Klein A, et al. Tracing hepatitis B virus to the 16th century in a Korean mummy. Hepatology. 2012 Nov. 56(5):1671-80. [QxMD MEDLINE Link].

18. Gish RG, Locarnini S. Chronic hepatitis B viral infection. Yamada T, ed. Textbook of Gastroenterology. 5th ed. Oxford, UK: Blackwell Publishing; 2009. 2112-38.

19. Azmi AN, Tan SS, Mohamed R. Practical approach in hepatitis B e antigen-negative individuals to identify treatment candidates. World J Gastroenterol. 2014 Sep 14. 20(34):12045-55. [QxMD MEDLINE Link]. [Full Text].

20. Jung MC, Diepolder HM, Pape GR. T cell recognition of hepatitis B and C viral antigens. Eur J Clin Invest. 1994 Oct. 24(10):641-50. [QxMD MEDLINE Link].

21. Chisari FV. Cytotoxic T cells and viral hepatitis. J Clin Invest. 1997 Apr 1. 99(7):1472-7. [QxMD MEDLINE Link]. [Full Text].

22. Kuo A, Gish R. Chronic hepatitis B infection. Clin Liver Dis. 2012 May. 16(2):347-69. [QxMD MEDLINE Link].

23. Tong W, He J, Sun L, He S, Qi Q. Hepatitis B virus with a proposed genotype I was found in Sichuan Province, China. J Med Virol. 2012 Jun. 84(6):866-70. [QxMD MEDLINE Link].

24. Sonneveld MJ, Rijckborst V, Zeuzem S, et al. Presence of precore and core promoter mutants limits the probability of response to peginterferon in hepatitis B e antigen-positive chronic hepatitis B. Hepatology. 2012 Jul. 56(1):67-75. [QxMD MEDLINE Link].

25. Fattovich G, Giustina G, Christensen E, et al. Influence of hepatitis delta virus infection on morbidity and mortality in compensated cirrhosis type B. The European Concerted Action on Viral Hepatitis (Eurohep). Gut. 2000 Mar. 46(3):420-6. [QxMD MEDLINE Link]. [Full Text].

26. Wursthorn K, Manns MP, Wedemeyer H. Natural history: the importance of viral load, liver damage and HCC. Best Pract Res Clin Gastroenterol. 2008. 22(6):1063-79. [QxMD MEDLINE Link].

27. Heidrich B, Serrano BC, Idilman R, et al. HBeAg-positive hepatitis delta: virological patterns and clinical long-term outcome. Liver Int. 2012 Oct. 32(9):1415-25. [QxMD MEDLINE Link].

28. Wang J, Zhao W, Cheng L, et al. CD137-mediated pathogenesis from chronic hepatitis to hepatocellular carcinoma in hepatitis B virus-transgenic mice. J Immunol. 2010 Dec 15. 185(12):7654-62. [QxMD MEDLINE Link]. [Full Text].

29. Thursz MR, Thomas HC, Greenwood BM, Hill AV. Heterozygote advantage for HLA class-II type in hepatitis B virus infection. Nat Genet. 1997 Sep. 17(1):11-2. [QxMD MEDLINE Link].

30. Jouanguy E, Lamhamedi-Cherradi S, Altare F, et al. Partial interferon-gamma receptor 1 deficiency in a child with tuberculoid bacillus Calmette-Guérin infection and a sibling with clinical tuberculosis. J Clin Invest. 1997 Dec 1. 100(11):2658-64. [QxMD MEDLINE Link]. [Full Text].

31. Zhou J, Chen DQ, Poon VK, et al. A regulatory polymorphism in interferon-gamma receptor 1 promoter is associated with the susceptibility to chronic hepatitis B virus infection. Immunogenetics. 2009 Jun. 61(6):423-30. [QxMD MEDLINE Link].

32. Frodsham AJ, Zhang L, Dumpis U, et al. Class II cytokine receptor gene cluster is a major locus for hepatitis B persistence. Proc Natl Acad Sci U S A. 2006 Jun 13. 103(24):9148-53. [QxMD MEDLINE Link]. [Full Text].

33. Alper CA, Kruskall MS, Marcus-Bagley D, et al. Genetic prediction of nonresponse to hepatitis B vaccine. N Engl J Med. 1989 Sep 14. 321(11):708-12. [QxMD MEDLINE Link].

34. Davila S, Froeling FE, Tan A, et al. New genetic associations detected in a host response study to hepatitis B vaccine. Genes Immun. 2010 Apr. 11(3):232-8. [QxMD MEDLINE Link].

35. [Guideline] Kowdley KV, Wang CC, Welch S, Roberts H, Brosgart CL. Prevalence of chronic hepatitis B among foreign-born persons living in the United States by country of origin. Hepatology. 2012 Aug. 56(2):422-33. [QxMD MEDLINE Link].

36. Tripathi N, Mousa OY. Hepatitis B. StatPearls [Internet]. 2021 Jul 18. [QxMD MEDLINE Link]. [Full Text].

37. Xie WY, Sun C, He H, Deng C, Sheng Y. Estimates of the prevalence of occult HBV infection in Asia: a systematic review and meta-analysis. Infect Dis (Lond). 2022 Dec. 54 (12):881-96. [QxMD MEDLINE Link].

38. Kim BK, Han KH, Ahn SH. Prevention of hepatocellular carcinoma in patients with chronic hepatitis B virus infection. Oncology. 2011. 81 Suppl 1:41-9. [QxMD MEDLINE Link].

39. Han YF, Zhao J, Ma LY, et al. Factors predicting occurrence and prognosis of hepatitis-B-virus-related hepatocellular carcinoma. World J Gastroenterol. 2011 Oct 14. 17(38):4258-70. [QxMD MEDLINE Link]. [Full Text].

40. Caputo R, Gelmetti C, Ermacora E, Gianni E, Silvestri A. Gianotti-Crosti syndrome: a retrospective analysis of 308 cases. J Am Acad Dermatol. 1992 Feb. 26(2 Pt 1):207-10. [QxMD MEDLINE Link].

41. [Guideline] Terrault NA, Bzowej NH, Chang KM, et al, for the American Association for the Study of Liver Diseases. AASLD guidelines for treatment of chronic hepatitis B. Hepatology. 2016 Jan. 63(1):261-83. [QxMD MEDLINE Link]. [Full Text].

42. Arora S, Martin CL, Herbert M. Myth: interpretation of a single ammonia level in patients with chronic liver disease can confirm or rule out hepatic encephalopathy. CJEM. 2006 Nov. 8(6):433-5. [QxMD MEDLINE Link]. [Full Text].

43. [Guideline] Centers for Disease Control and Prevention. 2015 Sexually transmitted diseases treatment guidelines. Viral hepatitis. Centers for Disease Control and Prevention. Available at https://www.cdc.gov/std/tg2015/hepatitis.htm. June 4, 2015; Accessed: May 26, 2017.

44. Finnish Medical Society Duodecim. Viral hepatitis. EBM Guidelines. Evidence-Based Medicine [Internet]. Helsinki, Finland: Wiley Interscience; 2008.

45. New York State Department of Health. Hepatitis B virus. New York, NY: New York State Department of Health; 2008. Available at http://guideline.gov/content.aspx?id=12812. Accessed: June 13, 2013.

46. [Guideline] U.S. Preventive Services Task Force. Hepatitis B virus infection in adolescents and adults: screening. December 15, 2020. Available at https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/hepatitis-b-virus-infection-screening. Accessed: December 2, 2021.

47. Barclay L. USPSTF shifts course, favors hepatitis B screening. Medscape Medical News. Available at http://www.medscape.com/viewarticle/825948. May 30, 2014; Accessed: June 2, 2014.

48. LeFevre ML, U.S. Preventive Services Task Force. Screening for hepatitis B virus infection in nonpregnant adolescents and adults: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2014 Jul 1. 161(1):58-66. [QxMD MEDLINE Link].

49. Chou R, Dana T, Bougatsos C, Blazina I, Khangura J, Zakher B. Screening for hepatitis B virus infection in adolescents and adults: a systematic review to update the U.S. Preventive Services Task Force recommendation. Ann Intern Med. 2014 Jul 1. 161(1):31-45. [QxMD MEDLINE Link].

50. Rajbhandari R, Chung RT. Screening for hepatitis B virus infection: a public health imperative. Ann Intern Med. 2014 Jul 1. 161(1):76-7. [QxMD MEDLINE Link].

51. Eckman MH, Kaiser TE, Sherman KE. The cost-effectiveness of screening for chronic hepatitis B infection in the United States. Clin Infect Dis. 2011 Jun. 52(11):1294-306. [QxMD MEDLINE Link]. [Full Text].

52. [Guideline] Terrault NA, Lok ASF, McMahon BJ, et al. Update on prevention, diagnosis, and treatment of chronic hepatitis B: AASLD 2018 hepatitis B guidance. Hepatology. 2018 Apr. 67 (4):1560-99. [QxMD MEDLINE Link]. [Full Text].

53. [Guideline] Centers for Disease Control and Prevention. Testing recommendations for hepatitis C virus infection. July 29, 2020. Available at https://www.cdc.gov/hepatitis/hcv/guidelinesc.htm. Accessed: December 2, 2021.

54. Trinchet JC, Chaffaut C, Bourcier V, et al. Ultrasonographic surveillance of hepatocellular carcinoma in cirrhosis: a randomized trial comparing 3- and 6-month periodicities. Hepatology. 2011 Dec. 54(6):1987-97. [QxMD MEDLINE Link].

55. US Food and Drug Administration. 510(k) Premarket notification: Hepatiq. Available at http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfpmn/pmn.cfm?ID=K142891. Accessed: January 11, 2015.

56. Business Wire. FDA clears Hepatiq [press release]. Hepatiq: Hepatic Quantitation. Available at http://www.hepatiq.com/fdaclearshepatiq.html. Accessed: January 11, 2015.

57. National Institute of Diabetes and Digestive and Kidney Diseases. HALT-C (Hepatitis C Antiviral Long-term Treatment against Cirrhosis) trial website. Available at http://archives.niddk.nih.gov/haltctrial/displaypage.aspx?pagename=haltctrial/index.htm. Accessed: January 11, 2015.

58. Srinivasa Babu A, Wells ML, Teytelboym OM, et al. Elastography in chronic liver disease: modalities, techniques, limitations, and future directions. Radiographics. 2016 Nov-Dec. 36(7):1987-2006. [QxMD MEDLINE Link]. [Full Text].

59. [Guideline] World Health Organization. Guidelines for the prevention, care and treatment of persons with chronic hepatitis B infection. Geneva, Switzerland; WHO. 2015 Mar. [QxMD MEDLINE Link]. [Full Text].

60. Nebbia G, Peppa D, Maini MK. Hepatitis B infection: current concepts and future challenges. QJM. 2012 Feb. 105(2):109-13. [QxMD MEDLINE Link]. [Full Text].

61. Lok AS, McMahon BJ. Chronic hepatitis B: update 2009. Hepatology. 2009 Sep. 50(3):661-2. [QxMD MEDLINE Link]. [Full Text].

62. [Guideline] Papatheodoridis G, Buti M, Cornberg M, et al, for the European Association for the Study of the Liver. EASL clinical practice guidelines: Management of chronic hepatitis B virus infection. J Hepatol. 2012 Jul. 57(1):167-85. [QxMD MEDLINE Link]. [Full Text].

63. [Guideline] Liaw YF, Leung N, Kao JH, et al. Asian-Pacific consensus statement on the management of chronic hepatitis B: a 2008 update. Hepatol Int. 2008 Sep. 2(3):263-83. [QxMD MEDLINE Link]. [Full Text].

64. [Guideline] Sherman M, Shafran S, Burak K, et al. Management of chronic hepatitis B: consensus guidelines. Can J Gastroenterol. 2007 Jun. 21 Suppl C:5C-24C. [QxMD MEDLINE Link]. [Full Text].

65. [Guideline] Kennedy PT, Lee HC, Jeyalingam L, et al. NICE guidelines and a treatment algorithm for the management of chronic hepatitis B: a review of 12 years experience in west London. Antivir Ther. 2008. 13(8):1067-76. [QxMD MEDLINE Link].

66. Keeffe EB, Dieterich DT, Han SH, et al. A treatment algorithm for the management of chronic hepatitis B virus infection in the United States: an update. Clin Gastroenterol Hepatol. 2006 Aug. 4(8):936-62. [QxMD MEDLINE Link].

67. New York State Department of Health. Prevention of secondary disease: preventive medicine. Viral hepatitis. New York, NY: New York State Department of Health; 2010. Available at http://guideline.gov/content.aspx?id=24043. Accessed: June 13, 2013.

68. Pharmasset voluntarily halts clinical studies with clevudine in hepatitis B infected patients. Medical News Today. Available at http://www.medicalnewstoday.com/releases/146749.php. April 21, 2009; Accessed: June 13, 2013.

69. Mutimer D, Naoumov N, Honkoop P, et al. Combination alpha-interferon and lamivudine therapy for alpha-interferon-resistant chronic hepatitis B infection: results of a pilot study. J Hepatol. 1998 Jun. 28(6):923-9. [QxMD MEDLINE Link].

70. Gara N, Zhao X, Collins MT, et al. Renal tubular dysfunction during long-term adefovir or tenofovir therapy in chronic hepatitis B. Aliment Pharmacol Ther. 2012 Jun. 35(11):1317-25. [QxMD MEDLINE Link]. [Full Text].

71. Lange CM, Bojunga J, Hofmann WP, et al. Severe lactic acidosis during treatment of chronic hepatitis B with entecavir in patients with impaired liver function. Hepatology. 2009 Dec. 50(6):2001-6. [QxMD MEDLINE Link].

72. Wong DK, Cheung AM, O'Rourke K, Naylor CD, Detsky AS, Heathcote J. Effect of alpha-interferon treatment in patients with hepatitis B e antigen-positive chronic hepatitis B. A meta-analysis. Ann Intern Med. 1993 Aug 15. 119(4):312-23. [QxMD MEDLINE Link].

73. Tseng TC, Liu CJ, Su TH, et al. Serum hepatitis B surface antigen levels predict surface antigen loss in hepatitis B e antigen seroconverters. Gastroenterology. 2011 Aug. 141(2):517-25, 525.e1-2. [QxMD MEDLINE Link].

74. Yi Z, Jie YW, Nan Z. The efficacy of anti-viral therapy on hepatitis B virus-associated glomerulonephritis: A systematic review and meta-analysis. Ann Hepatol. 2011 Apr-Jun. 10(2):165-73. [QxMD MEDLINE Link].

75. Guillevin L, Mahr A, Cohen P, et al. Short-term corticosteroids then lamivudine and plasma exchanges to treat hepatitis B virus-related polyarteritis nodosa. Arthritis Rheum. 2004 Jun 15. 51(3):482-7. [QxMD MEDLINE Link].

76. Lau GK, Piratvisuth T, Luo KX, et al. Peginterferon Alfa-2a, lamivudine, and the combination for HBeAg-positive chronic hepatitis B. N Engl J Med. 2005 Jun 30. 352(26):2682-95. [QxMD MEDLINE Link].

77. Marcellin P, Lau GK, Bonino F, et al. Peginterferon alfa-2a alone, lamivudine alone, and the two in combination in patients with HBeAg-negative chronic hepatitis B. N Engl J Med. 2004 Sep 16. 351(12):1206-17. [QxMD MEDLINE Link].

78. Tenney DJ, Pokornowski KA, Rose RE, et al. Entecavir maintains a high genetic barrier to HBV resistance through 6 years in naive patients [abstract]. J Hepatol. 2009. 50(Suppl 1):S10.

79. Wong GL, Wong VW, Chan HY, et al. Undetectable HBV DNA at month 12 of entecavir treatment predicts maintained viral suppression and HBeAg-seroconversion in chronic hepatitis B patients at 3 years. Aliment Pharmacol Ther. 2012 Jun. 35(11):1326-35. [QxMD MEDLINE Link].

80. Chang TT, Gish RG, de Man R, et al. A comparison of entecavir and lamivudine for HBeAg-positive chronic hepatitis B. N Engl J Med. 2006 Mar 9. 354(10):1001-10. [QxMD MEDLINE Link].

81. Chang TT, Lai CL, Kew Yoon S, et al. Entecavir treatment for up to 5 years in patients with hepatitis B e antigen-positive chronic hepatitis B. Hepatology. 2010 Feb. 51(2):422-30. [QxMD MEDLINE Link].

82. Schiff ER, Lee SS, Chao YC, et al. Long-term treatment with entecavir induces reversal of advanced fibrosis or cirrhosis in patients with chronic hepatitis B. Clin Gastroenterol Hepatol. 2011 Mar. 9(3):274-6. [QxMD MEDLINE Link].

83. Schnittman SM, Pierce PF. Potential role of lamivudine (3TC) in the clearance of chronic hepatitis B virus infection in a patient coinfected with human immunodeficiency virus type. Clin Infect Dis. 1996 Sep. 23(3):638-9. [QxMD MEDLINE Link].

84. Dienstag JL, Schiff ER, Wright TL, et al. Lamivudine as initial treatment for chronic hepatitis B in the United States. N Engl J Med. 1999 Oct 21. 341(17):1256-63. [QxMD MEDLINE Link].

85. Grellier L, Mutimer D, Ahmed M, et al. Lamivudine prophylaxis against reinfection in liver transplantation for hepatitis B cirrhosis. Lancet. 1996 Nov 2. 348(9036):1212-5. [QxMD MEDLINE Link].

86. Gatanaga H, Hayashida T, Tanuma J, Oka S. Prophylactic effect of antiretroviral therapy on hepatitis B virus infection. Clin Infect Dis. 2013 Jun. 56(12):1812-9. [QxMD MEDLINE Link].

87. Tipples GA, Ma MM, Fischer KP, Bain VG, Kneteman NM, Tyrrell DL. Mutation in HBV RNA-dependent DNA polymerase confers resistance to lamivudine in vivo. Hepatology. 1996 Sep. 24(3):714-7. [QxMD MEDLINE Link].

88. Honkoop P, Niesters HG, de Man RA, Osterhaus AD, Schalm SW. Lamivudine resistance in immunocompetent chronic hepatitis B. Incidence and patterns. J Hepatol. 1997 Jun. 26(6):1393-5. [QxMD MEDLINE Link].

89. Marcellin P, Chang TT, Lim SG, et al. Adefovir dipivoxil for the treatment of hepatitis B e antigen-positive chronic hepatitis B. N Engl J Med. 2003 Feb 27. 348(9):808-16. [QxMD MEDLINE Link].

90. Hadziyannis SJ, Tassopoulos NC, Heathcote EJ, et al. Long-term therapy with adefovir dipivoxil for HBeAg-negative chronic hepatitis B. N Engl J Med. 2005 Jun 30. 352(26):2673-81. [QxMD MEDLINE Link].

91. Yang H, Westland CE, Delaney WE 4th, et al. Resistance surveillance in chronic hepatitis B patients treated with adefovir dipivoxil for up to 60 weeks. Hepatology. 2002 Aug. 36(2):464-73. [QxMD MEDLINE Link].

92. Villeneuve JP, Durantel D, Durantel S, et al. Selection of a hepatitis B virus strain resistant to adefovir in a liver transplantation patient. J Hepatol. 2003 Dec. 39(6):1085-9. [QxMD MEDLINE Link].

93. Angus P, Vaughan R, Xiong S, et al. Resistance to adefovir dipivoxil therapy associated with the selection of a novel mutation in the HBV polymerase. Gastroenterology. 2003 Aug. 125(2):292-7. [QxMD MEDLINE Link].

94. Chang TT, Lai CL. Hepatitis B virus with primary resistance to adefovir. N Engl J Med. 2006 Jul 20. 355(3):322-3; author reply 323. [QxMD MEDLINE Link].

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97. Marcellin P, Jacobson I, Habersetzer F, et al. Tenofovir disoproxil fumarate (TDF) for the treatment of HBeAg-negative chronic hepatitis B: week 72 TDF data and week 24 adefovir dipivoxil switch data (study 102) [abstract]. J Hepatol. 2008. 48(suppl 2):S26.

98. Marcellin P, Heathcote EJ, Buti M, et al. Tenofovir disoproxil fumarate versus adefovir dipivoxil for chronic hepatitis B. N Engl J Med. 2008 Dec 4. 359(23):2442-55. [QxMD MEDLINE Link].

99. American College of Obstetricians and Gynecologists. ACOG Practice Bulletin No. 86: Viral hepatitis in pregnancy. Obstet Gynecol. 2007 Oct. 110(4):941-56. [QxMD MEDLINE Link].

100. US Preventive Services Task Force. Screening for hepatitis B virus infection in pregnancy: U.S. Preventive Services Task Force reaffirmation recommendation statement. Ann Intern Med. 2009 Jun 16. 150(12):869-73, W154. [QxMD MEDLINE Link].

101. [Guideline] World Health Organization. Prevention of mother-to-child transmission of hepatitis B virus: guidelines on antiviral prophylaxis in pregnancy. Geneva, Switzerland. 2020 Jul. [QxMD MEDLINE Link]. [Full Text].

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Nikolaos T Pyrsopoulos, MD, PhD, MBA, FACP, AGAF, FAASLD, FRCP(Edin) Professor and Chief, Division of Gastroenterology and Hepatology, Professor of Physiology, Pharmacology, and Neuroscience, Medical Director of Liver Transplantation, Rutgers New Jersey Medical School

Nikolaos T Pyrsopoulos, MD, PhD, MBA, FACP, AGAF, FAASLD, FRCP(Edin) is a member of the following medical societies: American Association for the Study of Liver Diseases, American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Liver Foundation, American Medical Association, American Society for Gastrointestinal Endoscopy, American Society of Transplantation, International Liver Transplantation Society, Transplantation Society

Disclosure: Received research grant from: GRIFOLS. BAYER, DURECT, INTERCEPT, BEIGENE, BMS.

Ranya Selim, MD Gastroenterologist/Transplant Hepatologist

Ranya Selim, MD is a member of the following medical societies: American College of Gastroenterology

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

BS Anand, MD Professor, Department of Internal Medicine, Division of Gastroenterology, Baylor College of Medicine

BS Anand, MD is a member of the following medical societies: American Association for the Study of Liver Diseases, American College of Gastroenterology, American Gastroenterological Association, American Society for Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.

George Y Wu, MD, PhD Professor, Department of Medicine, Director, Hepatology Section, Herman Lopata Chair in Hepatitis Research, University of Connecticut School of Medicine

George Y Wu, MD, PhD is a member of the following medical societies: American Association for the Study of Liver Diseases, American Gastroenterological Association, American Medical Association, American Society for Clinical Investigation, and Association of American Physicians

Disclosure: Springer Consulting fee Consulting; Gilead Consulting fee Review panel membership; Gilead Honoraria Speaking and teaching; Bristol-Myers Squibb Honoraria Speaking and teaching; Springer Royalty Review panel membership

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