On July 20-21, 2024, on the eve of "World Hepatitis Day", the China Foundation for Hepatitis Prevention and Control, together with the Chinese Center for Disease Control and Prevention, the Chinese Medical Association, the Chinese Preventive Medicine Association and other units, held the "2024 World Hepatitis Day Publicity Conference and Hepatitis Elimination Action Conference" in Beijing. During the meeting, in a parallel meeting on the progress of chronic hepatitis B diagnosis and treatment, Li Zengde, Secretary-General of the China Hepatitis Prevention and Control Foundation, and the participating hepatologists discussed the new strategies and cutting-edge progress of chronic hepatitis B diagnosis and treatment. Professor Xu Xiaoyuan from Peking University First Hospital, Professor Wang Hui from Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Professor He Yingli from the First Affiliated Hospital of Xi'an Jiaotong University, Professor Liu Zhihua from Nanfang Hospital Affiliated to Southern Medical University, Professor Zhu Yueyong from the First Affiliated Hospital of Fujian Medical University, and Professor Li Jie from Drum Tower Hospital Affiliated to Nanjing University School of Medicine were invited to give wonderful special reports. At the same time, the experts and scholars attending the meeting had in-depth discussions at the meeting.
"Positive Action, Healing in the Future" 2024 Academic Conference on Progress in Diagnosis and Treatment of Chronic Hepatitis B - Illuminating the Road to Functional Cure of Chronic Hepatitis B
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Secretary-General Li Zengde
At the beginning of the conference, Li Zengde, Secretary-General of the China Hepatitis Prevention and Control Foundation, made an opening speech. Secretary-General Li Zengde emphasized the importance of the progress of diagnosis and treatment of chronic hepatitis B, and pointed out that with the continuous development and progress of medical science and technology in mainland China, we now have the objective conditions to eliminate the harm of hepatitis, the treatment concept is more active, the safety and accessibility of drugs have been greatly improved, and a variety of examination and testing methods are becoming more and more mature and accessible. This has created conditions for us to actively carry out the prevention and treatment of chronic hepatitis B, consolidate and improve the immune barrier, actively screen and detect infected patients as soon as possible, actively treat, expand the indications for treatment, achieve full treatment, strengthen follow-up management, and form a closed-loop or whole-process disease management model. Secretary-General Li Zengde called on scientists and enterprises to accelerate the research and development of new drugs and contribute to the realization of "Healthy China" and the goal of eliminating the harm of hepatitis.
Insight 2024: A new direction for the prevention and treatment of chronic hepatitis B from the WHO guidelines
Professor Xu Xiaoyuan
Professor Xu Xiaoyuan combined with the latest edition of the "Guidelines for the Prevention, Diagnosis, Care and Treatment of Chronic Hepatitis B" issued by the WHO in 2024, and deeply analyzed the new trends in the prevention and treatment of chronic hepatitis B. At present, the global burden of hepatitis B is still heavy, and eliminating the harm of viral hepatitis is facing great challenges. The new WHO guidelines emphasize that 2024~2026 is a window period for global hepatitis prevention and control. Professor Xu Xiaoyuan pointed out that China's guidelines for the diagnosis and treatment of hepatitis B have been at the forefront of the world, but continuous efforts are still needed. Despite the effectiveness of hepatitis B vaccine prevention, hepatitis B diagnosis and treatment need to be strengthened. He stressed the importance of simplifying antiviral therapy, pointed out the need to expand access to treatment, and demonstrated the effectiveness of antiviral therapy in reducing the incidence of liver cancer and cirrhosis through real-world data analysis. Professor Xu said that the Chinese Society of Hepatology is still working hard to expand the treatment and further supplement the existing guidelines.
Exploring the fog of treatment and expanding treatment to rethink and practice
Professor Wang Hui
Professor Wang Hui further discussed the necessity and practice of the expanded treatment of chronic hepatitis B. She pointed out that expanding antiviral therapy is an important strategy to control the disease and prolong the survival of patients with chronic hepatitis B. With the improvement of drug accessibility and safety, the treatment indications should be gradually expanded to achieve complete treatment. Professor Wang Hui emphasized that patients aged > 30 years should start antiviral therapy, which is a very important indication in the new version of the mainland guidelines to expand the treatment strategy. Studies have shown that patients aged > 30 years have significantly increased levels of fibrosis and inflammation, which are risk factors for disease progression and liver cancer. In addition, factors such as the degree of liver fibrosis and family history are also key to considering antiviral therapy. Through a number of clinical studies and data analysis, Professor Wang Hui demonstrated the remarkable effect of expanded treatment in reducing disease progression and the risk of liver cancer, and pointed out that the treatment regimen should be continuously optimized in the future, especially for patients in the immunotolerant stage.
Building a line of defense against liver cancer Antiviral treatment strategies for patients with chronic hepatitis B from the perspective of the whole process management of liver cancer
Professor He Yingli
From the perspective of the whole process management of liver cancer, Professor He Yingli deeply analyzed the important role of antiviral treatment strategies for chronic hepatitis B in the prevention of liver cancer. He began by emphasizing the importance of antiviral therapy in slowing the progression of hepatitis B cirrhosis, reducing the risk of liver cancer, and improving the quality of life of patients. Professor He pointed out that hepatitis B is the main cause of liver cancer in mainland China, and the incidence of liver cancer can be effectively reduced through a tertiary prevention strategy. Especially in secondary prevention, standardized antiviral therapy can significantly reduce viral load and reduce the risk of liver cancer. At the same time, Professor He shared a number of research data that confirmed the advantages of first-line drugs such as tenofovir disoproxil (TDF) in reducing the incidence of liver cancer and improving prognosis. Professor He also emphasized the importance of stratified management and integrated treatment for high-risk populations. He called for strengthening the full management of CHB patients and optimizing antiviral treatment strategies to further reduce the burden of liver cancer.
30+ CHB patients How to manage patients of childbearing age throughout the whole process under the new guidelines
Professor Liu Zhihua
Professor Liu Zhihua elaborated on the whole-process management strategy of the new version of the hepatitis B guidelines in mainland China for patients over 30 years old with chronic hepatitis B in the childbearing age. Professor Liu Zhihua pointed out that the treatment of patients of childbearing age should take into account the efficacy and pregnancy needs, and proposed treatment and follow-up management plans in the pre-pregnancy, pregnancy and postpartum stages. He stressed that high viral load is a major risk of mother-to-child transmission and that antiviral therapy is crucial in interrupting mother-to-child transmission, and shared the latest research data showing the significant effectiveness of antiviral therapy in reducing the rate of mother-to-child transmission. At the same time, Professor Liu Zhihua discussed in detail the safety of different antiviral drugs during pregnancy and lactation, and pointed out that TDF is the preferred drug. Finally, Professor Liu Zhihua summarized the key points of the whole process management of patients of childbearing age, and emphasized the importance of individualized treatment and follow-up management to ensure the health of mothers and children and the realization of the goal of hepatitis B prevention and control.
Optimize treatment strategies and manage the safety of antiviral therapy
Professor Zhu Yueyong
In his report, Professor Zhu Yueyong focused on optimizing treatment strategies and safety management of antiviral therapy. He pointed out that in the process of long-term antiviral therapy, it is necessary to pay close attention to the safety of drugs, especially for high-risk groups with dyslipidemia and renal impairment, which need to be individualized. Professor Zhu analyzed the effects of different antiviral drugs on blood lipids and kidneys in detail through a number of research data, and pointed out that the effect of TDF on blood lipids in 20 years of clinical application is relatively small, and the safety and tolerability of TDF in patients with normal renal function at baseline is good. In the long-term follow-up, no renal impairment caused by TDF treatment was found. Professor Zhu said that the current first-line oral antiviral drugs are generally safe and well tolerated, and antiviral therapy should be standardized before the arrival of a functional cure.
Towards a cure Explore the frontier pathways and strategies of functional cure for chronic hepatitis B
Professor Li Jie
In her speech, Professor Li Jie discussed in depth the cutting-edge path and strategy of functional cure of chronic hepatitis B. She emphasized that functional cure is not only the pursuit of clinicians, but also the urgent need of the majority of patients. Prof. Li Jie pointed out that surface antigen (HBsAg) clearance is important in reducing the risk of end-stage liver disease, but there are differences in HBsAg clearance between different antiviral drugs and different treatment modalities, and meta-analyses have shown that TDF is better than entecavir (ETV) in reducing HBsAg levels. Professor Li Jie mentioned that the current effect of nucleos(t)ide analogues or interferons alone is still not ideal, on the one hand, it is necessary to optimize the existing antiviral treatment regimen to prepare for functional cure; On the other hand, it is necessary to continue to explore new anti-hepatitis B drugs, and she emphasized that the current new drugs under development show the potential for functional cure, especially small nucleic acid drugs (including small interfering RNA and antisense oligonucleotides) have a bright future in reducing HBsAg, which is a hot spot for the research and development of new drugs for chronic hepatitis B, and is expected to bring better treatment options for patients with chronic hepatitis B in the future.
The experts and scholars at the meeting had a wonderful roundtable discussion on how to practice the hepatitis B prevention and treatment guidelines to identify potentially at-risk patients, and how to prepare for functional cure in the era of antiviral therapy.
Summary
With the successful conclusion of this academic conference on the progress of diagnosis and treatment of chronic hepatitis B, the wonderful speeches and in-depth discussions of experts pointed out a new direction for the prevention and treatment of chronic hepatitis B. It can be seen that the current concept of antiviral treatment for chronic hepatitis B is more active, the safety and accessibility of drugs have been greatly improved, and a variety of examination and testing methods are becoming more and more mature and accessible. With the continuous progress of the treatment concept of chronic hepatitis B and the research and development of new drugs, the dream of a functional cure for chronic hepatitis B will finally come true!