Editor's note: At the recent AASLD 2024, the annual meeting of the American Association for the Study of Liver Diseases, top experts from the global liver disease field gathered to share the latest breakthroughs in liver disease research and clinical practice. Hepatology Digest invited Dr. Terry Cheuk-Fung Yip and Dr. Jimmy Che-To Lai from the Chinese University of Hong Kong to provide a comprehensive overview of the highlights of the conference, exploring important advances in hepatitis B, metabolic-associated steatohepatitis and liver cirrhosis.Hepatology Digest: Both professors presented several oral presentations at this AASLD conference. Could you please briefly introduce the main results of these studies and their clinical significance?
Dr. Terry Yip: Yes, this year, I think AASLD has been truly amazing. They provided a lot of high-quality content, including both poster presentations and oral presentations. Yesterday, I attended two oral presentation sessions: one focused on chronic hepatitis B and another on metabolic dysfunction-associated steatotic liver disease, or MASLD.
For the hepatitis B session, I found it particularly interesting. Many presentations discussed factors associated with HBsAg seroclearance. Some important factors included stopping treatment and whether retreatment after stopping could impact the future chances of achieving HBsAg seroclearance. Additionally, some researchers examined the kinetics of serial HBsAg level measurements and explored whether this could predict the likelihood of achieving HBsAg seroclearance.
The session on MASLD was equally fascinating. There were detailed discussions about existing therapies and how they can benefit our patients. For example, GLP-1 receptor agonists and related dual/triple agonists, which are currently in phase two and phase three trials, have shown remarkable success in improving hepatic steatosis and fibrosis in MASLD patients. Since we already use GLP-1 receptor agonists for many of our patients with type 2 diabetes and obesity, investigators shared valuable insights into how these drugs might also help patients with MASLD. These benefits include improving cardiovascular function, reducing the risk of major cardiovascular events, and addressing liver-related issues.
These two topics were undoubtedly major highlights of the conference for me.
Dr. Jimmy Che-To Lai: Yes, I fully agree with Terry. The Liver Meeting this year has been wonderful, with a variety of oral presentations, not only on hepatitis B and MASLD but also on portal hypertension and cirrhosis.
Just now, there was a plenary session on portal hypertension and cirrhosis that I found particularly fascinating. One oral presentation discussed cirrhotic cardiomyopathy and the use of point-of-care ultrasound to further assess the fluid status of patients. This approach can help identify patients at risk of acute kidney injury and determine factors contributing to such risks.
Another interesting trial explored whether the duration of octreotide treatment affects the risk of early rebleeding in patients with variceal bleeding. All of this research is incredibly thought-provoking and provides data that may eventually inform clinical practices.
Regarding portal hypertension and cirrhosis, there has been a lot of great work going on. These findings stimulate us to think about what more we can do in the future to refine treatment algorithms. Hopefully, future studies and practice updates will help improve patient outcomes by building on this robust body of work.
Hepatology Digest: This year, you have attended the three major conferences of APASL, EASL, and AASLD. What is the biggest harvest? What insights do these meetings offer for the future research directions of the two individuals?
Dr. Terry Yip: Yes, this year, we attended all three major conferences: APASL, EASL, and now the Liver Meeting by AASLD. I think all these conferences were very interesting and offered unique perspectives. At APASL, for instance, I gained a lot of insights into the Asian Pacific perspective on how we treat diseases. Given that my focus is on hepatitis B and metabolic dysfunction-associated steatotic liver disease (MASLD), these topics were particularly relevant.
For hepatitis B, it’s a significant issue in the Asian Pacific region. At APASL, I learned more about how we use existing treatments to help patients and how we can foresee improvements with novel therapies in the future. Specifically, I gained valuable insights into managing patients in the so-called “indeterminate phase.” This group doesn’t fit neatly into the current four-phase classification of hepatitis B, based on HBeAg, HBV DNA and ALT levels, and is often referred to as a gray zone. Discussions at these conferences emphasized the hepatocellular carcinoma (HCC) risk in this group and whether treatment could improve their outcomes.
I think attending APASL, EASL, and AASLD has helped me deepen my understanding of this topic. Overall, my biggest takeaway is the need to refine how we classify and manage hepatitis B patients, particularly those in the gray zone, and to prepare for the integration of novel therapies in future clinical practice.
Dr. Jimmy Che-To Lai: Yes, I fully agree with Terry. We’ve attended all three conferences together, like conference buddies—and they’ve all been incredibly insightful. Apart from hepatitis B, one of the standout topics across these meetings has been fatty liver diseases, including MASLD.
The prevalence of fatty liver disease continues to rise worldwide, and researchers are delving into the metabolic burden as well as the role of alcohol use. One of the fascinating areas of discussion is whether alcohol use interacts with or influences the natural history and progression of steatotic liver disease. There are still many unanswered questions, but these conferences have provided new data and insights into this area.
Portal hypertension and cirrhosis also remain key topics in hepatology. What struck me at these conferences was the regional variation in practice. However, a common theme is the growing push towards non-invasive assessments for liver fibrosis and portal hypertension. For example, techniques like spleen stiffness measurement and serum-based non-invasive assessments are gaining traction and have the potential to change how we assess and manage liver disease.
The field is clearly moving away from invasive procedures toward non-invasive methods that can guide treatment for patients with clinically significant portal hypertension. These developments are not only exciting but also hold great promise for improving patient care and outcomes. I believe that as these tools and algorithms are refined, they will become integral to how we treat and manage liver diseases in the future.
Hepatology Digest: I noticed that you have had face-to-face exchanges with many experts. Which expert’s research interests you most? Can you share your feelings?
Dr. Terry Yip: For me, I really treasure the opportunity to talk to different experts during these major conferences, including APASL, EASL, and AASLD. One of the highlights for me is walking around the poster hall. It’s incredibly rewarding because investigators often stand by their posters, and I can directly discuss their research with them.
One area of particular interest to me is the use of two-step algorithms for diagnosing advanced fibrosis in patients with MASLD. As proposed by the Liver Societies, the two-step algorithm involves using a first-line test, such as FIB-4, followed by a second-line test like liver stiffness measurement (LSM) by transient elastography or the enhanced liver fibrosis (ELF) test for patients with intermediate first-line test results.
Across these conferences, I’ve seen several centers working on validating this algorithm to streamline referrals in their systems. I had the chance to discuss this with some of the investigators and learned about the challenges they face in implementing the algorithm. One major obstacle is that many patients with MASLD are managed in primary care settings. Building trust and fostering collaboration with primary care physicians and endocrinologists is essential. For example, we should encourage primary care physicians to calculate FIB-4 scores and act on the results by referring patients with elevated scores for further evaluation.
While the two-step algorithm is theoretically robust, its practical implementation requires significant effort in trust-building and coordination among colleagues. These conversations with experts have been eye-opening, highlighting the need to address these barriers to realize the algorithm’s full potential in clinical practice.
Dr. Jimmy Che-To Lai: Yes, I fully agree with Terry. Walking around the poster halls at these conferences is always a great experience. It provides opportunities to reconnect with long-term collaborators we’ve worked with on various projects and to meet new researchers who could foster future collaborations. These interactions can create larger databases and allow us to tackle research questions from multiple perspectives.
At these conferences, I had the chance to engage in many fruitful discussions with researchers from around the world. These exchanges not only help me understand what others are doing but also inspire new ideas for my own work.
Hepatology Digest: I have observed that the relationship between the two professors is very harmonious. Are you also working on a joint research project? How do you help each other and make progress together?
Dr. Terry Yip: Yes, of course, Jimmy and I have a lot of collaboration because we are from the same institution, the Chinese University of Hong Kong, and we have been friends for many years. We also talk about research a lot during our work. Although our research interests are different, Jimmy focuses more on portal hypertension, liver cirrhosis, and, in general, patients with advanced liver disease, while my research interests are more on hepatitis B and also patients with MAFLD or MASLD—there is significant overlap in our work.
For patients with chronic liver disease, some of them can develop advanced liver disease. That’s where we have a lot of crosstalk between the two of us. I often seek Jimmy’s advice on how to better analyze the data from patients with advanced liver disease so that I can gain more insights from the data and ensure we make the most of the valuable information we have collected over a long period of time.
Also, as Jimmy mentioned earlier about non-invasive tests, I’ve gained a lot of insights from him about using these methods in chronic liver disease. These insights have been very helpful for my work.
Dr. Jimmy Che-To Lai: My collaboration with Terry is not limited to patients with advanced diseases, but covers all liver disease patients from early to mid-stage to late stage.
We’ve already built a solid database in our field, and I believe we should fully utilize it to generate impactful results. These collaborations and discussions reinforce the importance of teamwork in advancing the field of hepatology, and I’m excited to see how these connections will shape future research directions.
