Editor’s Note:
From November 17-19, 2023, the “15th Chronic Viral Hepatitis Antiviral Treatment Difficulties and Hotspots Academic Conference” was grandly held in Chongqing. Sponsored by the Chinese Medical Journal Co., Ltd., organized by the Editorial Department of the Chinese Journal of Hepatology, and co-organized by the Hepatitis Group of the Chinese Society of Hepatology of the Chinese Medical Association (CMA), the Second Affiliated Hospital of Chongqing Medical University, and the Viral Hepatitis Research Institute of Chongqing Medical University, the conference focused on chronic viral hepatitis treatment and high-quality development of the discipline, providing a platform for information exchange and interaction among frontline clinicians and clinical researchers. Dr. Xiaoguang Dou from Shengjing Hospital of China Medical University, the chairman of the conference, shared the highlights and engaged in an in-depth interview on the hot topic of chronic hepatitis B clinical treatment. The content is organized for the readers’ benefit.
Conference Highlights：
Dr. Xiaoguang Dou: Welcome to the 15th Chronic Viral Hepatitis Antiviral Treatment Difficulties and Hotspots Conference. The conference consistently focuses on the difficulties and hotspots in clinical treatment of chronic viral hepatitis. Compared to previous conferences, there are four highlights in this one.
Firstly, this conference coincides with the 30th anniversary of the founding of the Chinese Journal of Hepatology. Over the past 30 years, the journal has grown from inception to becoming an academic benchmark in China’s field of hepatology. We are honored to review the development of the journal with hepatology experts and colleagues nationwide, staying true to our original aspiration and forging ahead, wishing the Chinese Journal of Hepatology further success!
Secondly, the conference focuses on China’s newly issued “Chronic Hepatitis B Prevention and Treatment Guidelines (2022 Edition).” Chaired by Dr. Hui Zhuang, Dr. Xiaoyuan Xu, Dr. Fusheng Wang, and Dr. Hong You, Dr. Yuemin Nan and several clinical hepatology experts meticulously analyzed and openly discussed unresolved issues in China’s chronic hepatitis B treatment guidelines. Academicians Zhuang Hui provided an excellent summary.
Thirdly, the expert reports were shorter, emphasizing discussion sessions. More experts participated, expressing their views on the difficulties and hotspots of clinical treatment of viral hepatitis, stimulating interest and enthusiasm among clinicians, hearing diverse opinions, hoping to find common ground while respecting differences, ultimately benefiting our patients.
Finally, the conference included a clinical case competition, covering not only viral hepatitis but also its complications, developments in infectology and hepatology, progress in new drugs for chronic hepatitis B, clinical treatment of liver failure, and other hot issues related to viral hepatitis, making the conference content-rich and varied.
“Clinical Cure” and “Disease Cure” of Chronic Hepatitis B
Dr. Xiaoguang Dou: The so-called virological cure, or clinical cure of hepatitis B, requires: firstly, the virus to be undetectable or eliminated; secondly, the disappearance of surface antigen (HBsAg), with or without surface antibody (anti-HBs antibody); and, thirdly, normal liver function indicators like ALT levels.
However, we need to consider whether the clinical cure of chronic hepatitis B means “disease cure.” Currently, the answer is no. As clinicians, we focus on a disease, aiming for its cure. Let’s reconsider the definition of chronic hepatitis B. Chronic hepatitis B, caused by the hepatitis B virus (HBV), is a chronic progressive disease with poor clinical outcomes—insidious disease progression, cirrhosis, and, if combined with other factors like COVID-19 infection, potential acute liver failure. Another severe outcome is HBV-related liver cancer, especially in our country, where patients have significantly extended survival due to over 20 years of antiviral treatment, aging, and often having other underlying diseases (like hypertension, diabetes), metabolic liver diseases (like fatty liver disease), which may exacerbate the disease.
Therefore, “disease cure” includes similar average lifespan (overall survival), quality of life as the healthy population, not just one indicator. Through discussing “clinical cure” and “disease cure” of chronic hepatitis B, I want to convey to patients that, although we cannot achieve disease cure yet, persistent long-term antiviral treatment can significantly halt disease progression, bringing patients’ survival and quality of life to the level of their healthy counterparts, marking our success in treatment.
Liver Cancer Risk in the New Context, How to Increase the Cure Rate?
Dr. Xiaoguang Dou: Currently, more attention is given to liver cancer risk related to chronic liver diseases. An observed data point is that from 2013 to 2022, China’s liver cancer incidence did not show a significant decrease. Why is that? The main causes of liver cancer in China are still related to HBV and HCV infections, as well as metabolic (non-alcoholic fatty liver) liver cancer. The reasons for the stable incidence of liver cancer in China can be summarized as follows.
First, the treatment rate for chronic hepatitis B patients in China is still low, with epidemiological evidence indicating only 20-30% receive treatment. Second, with active antiviral treatment, patients’ survival has extended, and many are over 60 years old. With aging, the incidence of metabolic liver cancer, in particular, is increasing. Third, many liver cancer patients have underlying cirrhosis, and long-term liver inflammation and fibrosis are the basis for liver cancer.
In summary, regular liver cancer screening, especially for the elderly with chronic hepatitis B and cirrhosis, remains necessary to improve early diagnosis and treatment of liver cancer, further enhancing patients’ survival and maximizing the cure rate.
