Hepatitis B Assessments – HAT Update Sept 2018
As you all know, some of the anti-viral medications used for the treatment of Hepatitis B changed to
generics in July 2018. This means that the majority of the anti-virals that are used in NZ for Hepatitis
B are no longer considered high cost. As a result, we need to rethink our Hepatitis B assessment
outcomes. IHT are working with Ed Gane, Hepatologist at the National Liver Unit and the Ministry of
Health, to develop new formal guidelines, but in the meantime we have developed the fol owing
interim guidelines.
HAT assessment of Hepatitis B:
All applicants who are Hep B positive applicant require the following information to determine an
outcome:
• HBeAg
• HBV DNA
• LFTs
• AFP
• a new Liver ultrasound
• Liver Fibroscan report (dated within 3 years of the current medical assessment)
ALL of this information is required to be able to determine the applicant’s current standard of
health. Each result provides essential information about whether the applicant needs anti-viral
medication, has fibrosis / cirrhosis, has HCC or any other complications relating to their Hepatitis B.
HAT to request:
For every Hepatitis B applicant, please request the following information BEFORE referring the case
to an MA:
FIR: Hepatitis B Tests:
Please provide an HBeAg, HBV DNA, LFTs, AFP, a recent Liver Ultrasound report, a Liver
Fibroscan report (dated within 3 years of the current medical assessment) and a current
medication list.
Note:
Liver Ultrasound – this should be a recent report.
Liver Fibroscan – this can be dated within the past 3 years.
Remember – not every country can do Fibroscans (e.g. Tonga) – if they state they cannot provide
one, please discuss the case with Daniel e / Rob.
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Summary of likely MA Outcomes:
Hep B Temporary Visas:
Hep B, no m
eds,no complications
AWC
Hep B, on meds, no complications
AWC
Hep B +/- meds, with complications :
NOT ASH
or
the outcome wil depend on visa length + exact complications
Discuss with Danielle / Rob
Note: complications include HCC, undetermined liver lesions, cirrhosis, Fibroscan >8.5kPA, varices etc
Hep B Residence Visas:
Hep B, no meds, no complications
ASH
NOT ASH – A4.10.1 Listed Condition:
Hep B, on meds, no complications
Hepatitis B surface antigen positive and meeting
criteria for anti-viral treatment in NZ
NOT ASH – A410.1 Listed Condition:
Hep B +/- meds, with complications OR at high
Severe, chronic or progressive renal or hepatic
risk of complications
disorders
Note: complications include HCC, undetermined liver lesions, cirrhosis, Fibroscan >8.5kPA, varices etc
Recommended NOT ASH Wording: A4.10.1 INZ Listed condition – Hep B on medication.
The applicant has Hepatitis B and is currently taking (name of medication) for this. The
applicant’s Hepatitis B with the associated medication is an A4.10.1 INZ Listed condition.
Recommended AWC Wording:
AWC Box notes:
• The applicant has Hepatitis B and is on anti-viral medication for this. The next visa
application will require the following information:
Conditional FIR: ‘Hepatitis B Test’
•
Please provide the following information – HbeAg, HBV DNA, LFTs, AFP, a new Liver
Ultrasound scan, Liver Fibroscan report (dated within 3 years of this visa application),
current examination findings, a medical diagnosis list and a current medication list.
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Background information for those who are interested:
Temporary Visas:
AWC outcom
e:
Anti-viral medications are no longer high cost for temporary visas.
Applicants w
ho are currently taking, or are likely to need anti-viral medications can be given an AWC
outcome.
AWC Box notes:
• The applicant has Hepatitis B and is on anti-viral medication for this. The next visa
application will require the following information:
Conditional FIR: ‘Hepatitis B Test’
•
Please provide the following information – HbeAg, HBV DNA, LFTs, AFP, a new Liver
Ultrasound scan, Liver Fibroscan report (dated within 3 years of this visa application),
current examination findings, a medical diagnosis list and a current medication list.
NOT ASH outcome:
Applicants who have cirrhosis / HCC or other complications secondary to their Hepatitis B are likely
to be considered NOT ASH.
However, occasionally, these applicants may be stable and considered suitable for a short visa
period.
Residence Visas:
IHT have been in contact with the MOH to discuss Hepatitis B, the Immigration Instructions and our
current legal requirements. Until we have any further information / advice from the MOH, we must
continue to follow the Immigration Instructions, as they are written.
The A4.10.1 INZ Listed Conditions include:
• Hepatitis B surface antigen positive and meeting criteria for anti-viral treatment in New
Zealand.
• Severe, chronic or progressive renal or hepatic disorders.
ASH Outcomes:
No medications or complications secondary to their Hepatitis B.
NOT ASH Outcomes:
These are unchanged and the MAs should continue to follow the current Hepatitis B guidelines for
Residence visa applications.
Anti-viral medication:
Applicants who are currently on, or are recommended to start anti-viral medications are NOT ASH
under the A4.10.1 Listed condition of Hepatitis B.
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As per the 2016 Hep B Guidelines, this includes any applicant who is:
• HBeAg positive and ALT ≥40 for at least 6 months;
• HeA
g negative and HBV DNA ≥2000IU/mL and at least moderate liver fibrosis (Biopsy ≥F2;
Liver Stiffness ≥6kPA);
• He p B positive and is currently on, or is recommended to start anti-viral medication.
Recommended NOT ASH Wording:
• A4.10.1 INZ Listed condition – Hep B on medication.
o
The applicant has Hepatitis B and is currently taking (name of medication) for this.
The applicants Hepatitis B with the associated medication is an A4.10.1 INZ Listed
condition.
Liver related complications:
Applicants who currently have, or are considered high risk for future liver related complications
(irrespective of the need for anti-viral medication) are NOT ASH under:
A4.10.1 Listed condition of a severe, chronic or progressive hepatic disorder;
or
A4.10.1 Cancer condition (if they have HCC or suspected HCC).
As per the 2016 Hep B Guidelines, this includes any applicant who is:
• Hep B positive and has severe fibrosis (biopsy stage F3 or F4, OR fibroscan reading of
≥8.5kPA, OR any clinical, laboratory or radiologic evidence of cirrhosis);
• Previous or suspected HCC;
• Known Cirrhosis +/- complications such as varices.
Recommended NOT ASH Wording:
• A410.1 INZ Listed Condition – severe, chronic or progressive hepatic disorder OR cancer
depending on the specific issue.
o The MA can write this as they normally would. No specific wording needs to be used.
o However, the NOT ASH reasoning should focus on the liver related complication, not
on any medication they may be taking.
o This indicates to the Branch IO that the applicant has a significant long term
condition and that they should NOT be considering a waiver simply because the
medication is no longer high cost.
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