Invited Lecture(JSGE)
Thu. November 2nd   14:00 - 14:30   Room 11: Portopia Hotel South Wing Topaz
Invited Lecture1
 Towards functional cure of chronic hepatitis B
Grace LH Wong
The Chinese University of Hong Kong
As many as two billion people worldwide have once been exposed to hepatitis B virus (HBV) during their lifetime. Among them, more than 230 million would be chronically infected by the virus, leading to chronic inflammation and fibrosis of the liver. Approximately 890,000 people will die from hepatitis B. Asia is always an HBV hotspot, because of the huge population size and high prevalence rate of chronic HBV infection. Fortunately, there have been aggressive programmes of initiating universal HBV vaccination in newborns and young kids, which are proven to dramatically reduce the prevalence rate of HBV and hence liver cancer. It is a highly effective vaccination, with an efficacy of 95%-plus in the general population.

There are still millions of adults who were born before the era of HBV vaccination, who became chronically infected by the virus. As most chronic HBV patients are asymptomatic, screening is recommended to people who are at risk, namely people who come from areas of the world with a high prevalence of HBV, pregnant women, blood and/or organ donors, known exposure to HBV, or patients who are getting chemotherapy or immunosuppressants. Regular monitoring is needed to look for active disease and hence antiviral therapy is indicated. Antiviral therapy is generally in long-term, if not life-long. It is well-proven to reduce the risk of liver decompensation and cancer. Yet some recent studies suggest that stopping nucleos(t)ide analogue (NUC) after at least two years treatment and undetectable serum HBV DNA may result in higher rates of HBsAg seroclearance. The most consistent predictor of functional cure is low HBsAg level at the time of NUC withdrawal. By contrast, hepatitis flares are not predictive of HBsAg seroclearance or clinical remission after stopping NUC, and may lead to hepatic decompensation and death.

Reference:
Wong GLH, Gane E, Lok ASF. How to achieve functional cure of HBV: Stopping NUCs, adding interferon or new drug development? J Hepatol. 2022 Jun;76(6):1249-1262. https://linkinghub.elsevier.com/retrieve/pii/S0168-8278(21)02233-9
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