Editor's note: Recently, Combined GIHep&SHC 2024 was successfully held in Singapore. Experts in the field of liver disease from around the world gathered together to discuss the latest developments, challenges, and opportunities in liver disease. Reporters from Hepatology Digest rushed to the scene and conducted interviews with multiple experts. During the interview, Dr. Md Shofequnnabi Rumi, Assistant Professor at Enam Medical College Affiliated Hospital in Bangladesh, discussed the current status of treatment for viral hepatitis, metabolic associated fatty liver disease (MAFLD), hepatocellular carcinoma (HCC), and other related topics.Hepatology Digest: What is the current status of treatment for chronic hepatitis C and chronic hepatitis B?
Dr. Rumi: In the modern era, chronic hepatitis C is curable, and if patients receive appropriate treatment for about 12 to 24 weeks, they can achieve remission or complete cure. However, for chronic hepatitis B, there is no curative treatment available. In Asia and Western countries, the main concern has shifted to MAFLD, previously known as NAFLD, or fatty liver disease.
Hepatology Digest: In the field of hepatitis B treatment, what new treatment strategies or drugs are currently being developed? How much potential do you think we have in achieving a functional cure for hepatitis B?
Dr. Rumi: In our country, three drugs are commonly used in the treatment of chronic hepatitis B: entecavir, tenofovir alafenamide, and tenofovir disoproxil fumarate. All are available, but we frequently use and prefer entecavir because it is convenient and less expensive. This makes it affordable for patients, and those who take it regularly have good outcomes, though it is not a curative treatment. Currently, newer therapies such as NASVAC and other immune-modulated treatments are in phase III trials, and it is hoped that these new treatment methods can bring higher functional cure rates.
Hepatology Digest: Early diagnosis and treatment of hepatocellular carcinoma have always been difficult. What suggestions do you have for this?
Dr. Rumi: Early liver disease often presents no symptoms, so patients do not seek medical attention until the disease is advanced. If patients visit the doctor at an early stage, with very small tumor sizes, they can undergo resection or liver transplantation, which are curative options. However, when patients present at a late or advanced stage, curative treatment for hepatocellular carcinoma is not yet available. Therefore, I recommend regular surveillance for patients with chronic hepatitis B and C. In our country, since 2008, children receive hepatitis B vaccination after birth, included in the Expanded Program on Immunization (EPI). However, those born before 2008 are not vaccinated against hepatitis B.
I suggest regular routine checkups with simple ultrasound for patients with chronic hepatitis B and C, as well as for those with metabolic syndrome, diabetes mellitus, obesity, or hormonal disorders like hypothyroidism and dyslipidemia, to assess for fatty liver. In the modern era, worldwide, MAFLD is the main concern and leading cause of liver cirrhosis. Patients can prevent fatty liver by taking measures such as weight reduction and lifestyle changes.
Hepatology Digest: Regarding the progression of MAFLD to MASH and potentially further to hepatocellular carcinoma, what effective intervention methods do you think are currently available?
Dr. Rumi: MAFLD is now recognized as a histological diagnosis. MAFLD is reversible when patients reduce their weight by about 7 to 9 percent of their total body mass. Even fibrosis can be reversed with weight reduction. However, once a patient develops cirrhosis, it becomes irreversible. Many patients come to me with fatty liver and elevated liver enzyme levels, such as SGPT and SGOT. The first recommendation is lifestyle modification, including weight reduction, avoiding fatty foods, and abstaining from alcohol. For patients with MAFLD and other comorbidities like diabetes mellitus, dyslipidemia, hypothyroidism, or obesity, we often use semaglutide. Semaglutide helps with weight reduction and improves hyperglycemia or impaired glucose tolerance. My recent observation is that semaglutide is beneficial. For patients with fibrosis, we can use FXR agonists and other newer drugs, although their benefits are still under study.
