国际肝病采访APASL2009大会主席廖家杰教授

George K.K. Lau  Department of Medicine， The University of Hong Kong，Hong Kong SAR，China
 
Hepatology Digest: According to your study about PEG-IFN a-2a for HBeAg-positive chronic hepatitis B， we know that quantitative HBeAg is a useful adjunctive measurement for predicting HBeAg seroconversion in patients treated with PEG-IFN when considering both sensitivity and specificity compared with serum HBV DNA. So what’s your view on the future of quantitative HBeAg for predicting HBeAg seroconversion?

Pro. Lau: In the ordinary circumstances， we mainly pay attention to the HBV DNA level during the treatment of hepatitis B. But HBV DNA is not the target of the immune response; the immune response is antigen-antibody reaction， such as HBeAg， HBsAg and so on. Therefore， the negative conversion for HBeAg and HBsAg during treatment also needs to strive for. However， up to now we do not pay much attention to the decline in the HBeAg or HBsAg speed， we have just only paid much attention to observing the level of HBV DNA. We also know that the therapeutic response of HBV DNA and HBeAg， HBsAg is different. We can only carry out HBeAg and HBsAg qualitative detection before while now we can carry out HBeAg and HBsAg quantitative detection. During the process of antigen negative conversion， there will certainly be a decline phase. Then why should we monitor the speed of the antigen decline in the course of treatment? It is because this can help doctors assess the efficacy of follow-up and to shorten the course of treatment. If the antigen of the patients during the treatment of 6 months or 9 months did not decline， then there is no long-term efficacy either. In this case， we should adjust the treatment program as soon as possible. Studies have reported that for the patients who achieved HBeAg negative conversion during PEGASYS treatment， we can clearly see HBeAg decline to a certain extent in the 24 weeks， whose effect is better than monitoring HBV DNA. And if we use the rate of decline in HBeAg to assess the condition， there will be better clinical significance. Now what we want to do is HBsAg quantitative detection and it may be even better. It is because that the best treatment goal of hepatitis B is HBsAg negative conversion. Before HBsAg negative conversion it also declines and if not， how we can know whether the drugs we use is effective. It’s no use to see its decline after a year or two years. We can see its decline in the short term and its performance and whether our choice is right. I think we can know whether our treatment for hepatitis B is good through E antigen and S antigen quantitative detection five years later. This is forward-looking. It is insufficient to simply detect HBV NDA levels which represents the transcription but not the translation. HBeAg is a useful adjunctive measurement for predicting HBeAg seroconversion in patients treated with PEG-IFN when considering both sensitivity and specificity compared with serum HBV DNA.

Hepatology Digest: What’s your view on the future of therapeutic vaccination of chronic hepatitis B patients?

Pro. Lau: Therapeutic vaccine in chronic hepatitis B is a long way to go because we do not know which one is effective or how to enhance the immune response against hepatitis B by therapeutic vaccine itself. We need a cleared response for HBV DNA but not adverse reaction. While now a lot of work for this have not been done well and it is difficult to develop the therapeutic vaccine on this basis. The progress is very slow， almost none have been done for hepatitis B while only a little for hepatitis C. More and more people are engaged in immune research of hepatitis B and more work should be done for therapeutic vaccine of hepatitis B. We need to know what the changes are and what the insufficiency is so that we can in this regard to enhance the immune system and the therapeutic effect for patients with hepatitis B. Only do this that we can build a scientific platform to make this vaccine， At present， plenty of antigens have been identified and there are already a lot of antigens in our body. But it is not so simple. It is insufficient to know which epitope it is and the most important mechanisms have not been known clearly. As far as I am concerned， I think that the core antigen is more important. But it is difficult to build a platform to produce a large number of the core antigen to make this vaccine.

Hepatology Digest: APASL will be held in Hong Kong this year， would you please talk about the meeting as the president of APASL?

Pro. Lau: It is very exciting. First of all， it’s the first time that Chinese people to be the president of APASL. Second， there will be two continuous sessions of the meeting to be held in China， in Hong Kong this year and in Beijing next year. This is a very good international association for our Chinese in the liver disease research. APASL was formed in August 1978 in Singapore， it covers the region from China， Mongolia and Kazakhstan in the North， to New Zealand in the South， to the Pacific Islands in the East and Turkey and Egypt in the West. Our main objective of the association is to promote the scientific advancement and education of hepatology in the Asia Pacific region， including the exchange of information and the development of consensus in the field of hepatology. And it coordinates scientific studies between scientists and clinicians living in this region and encourages the practice of medicine in liver diseases. The membership shall be regular member and honorary member: Regular member may be hepatologists， gastroenterologists， radiologists， oncologists， medical practitioners， and research and biomedical industry workers who have demonstrated special interests or are actively engaged in clinical and/or basic research on liver and biliary tract disorders; And honorary members are distinguished persons who have rendered notable services to the Association or the advancement of the knowledge of liver and the biliary tract disorders and may on the recommendation of the Executive Committee be elected as honorary members by a simple majority at General Meetings. They will be permitted to attend all General and Scientific Meetings organized by the Association.