Interview with Prof. George K.K. Lau

Hepatology Digest: I’m here with Professor George Lau. First of all, I’d like to welcome you Professor Lau. Thank you for accepting our interview.

Pro. Lau: My pleasure.

Hepatology Digest: It’s a great honor. This is only the second time, since 1982, that Hong Kong has hosted the annual meeting for APASL. Can you tell us some of the important progress that we’ve made in the field since the last meeting?

Pro. Lau: There has been a tremendous growth in terms of participation and also the scientific content of this conference. This year, say for instance, we are anticipating around 4000 delegates coming to Hong Kong to join this annual meeting of the Asia Pacific Association for the Study of the Liver, and we have more than 150 faculties flying in from all parts of the world. They are all well-renown experts in the field of hepatitis, liver cancer and other fields of hepatology, who will come to join the meeting to share their views and the latest information and knowledge in the clinical management of liver diseases in the Asia Pacific region.

Hepatology Digest: The theme of the conference this year will be the multi-disciplinary approach to clinical hepatology. As the president of the 18th APASL meeting, can you further elaborate on the chosen theme, and also perhaps some highlights you’re expecting from this annual meeting?

Pro. Lau: The participants attending the meeting are mostly clinicians with more than 98% of them being clinical hepatologists. They are doctors taking care of patients with liver diseases and therefore, we decided to have the theme focused on clinical hepatology. Nowadays, because of the rapid developments in the various disciplines, people really need to come together and work as a team to take care of patients. Say for instance, we have radiologists, we have people who are very good at interventions, radiology, surgery, transplant surgeons, molecular biologists, physicians, hepatologists, and viralologist. They will all come together as a team to share their knowledge and to treat the patients so that we can deliver the best service for our liver disease patients. Therefore, we decided the theme of our conference to be the multi-disciplinary approach to clinical hepatology.
 
Hepatology Digest: Obviously, you will be an important speaker at this year’s meeting and one topic you’ll be speaking about is the management of chronic hepatitis B in the Asia Pacific region. What are your views on that topic?

Pro. Lau: Hepatitis B is still the most important cause of liver diseases in the Asia Pacific region.  Each year we have more that half a million people dying in the region because of hepatitis B related complications, that is liver cirrhosis and liver cancer. Now in 2009, we have a lot of Asians registering for the treatment of hepatitis B but we still do not have a perfect answer yet, and in fact, apart from the treatments available, we also have to face the community. There are a lot of activities, I believe, in the community that need to be activated so that our patients will no longer suffer from hepatitis B related liver diseases, that is liver cirrhosis and liver cancer. My talk will be focused on the latest developments in the clinical management of patients with chronic hepatitis B and how to prevent these patients from developing liver cancer and liver cirrhosis.  

Hepatology Digest: Moving on to more about the treatments. The big topic is, if and when nucleoside analogs can be stopped in HBV treatment. Can you give some of your views on when or if nucleoside analogs can be stopped?

Pro. Lau: Well, from an immunology point of view, nucleoside analogs can only be stopped when the host immune response to the virus has been restored. Now, unfortunately we do not have very good clinical markers, apart from s0 conversions to indicate that the host has already recovered. From an immunology point-of-view, that is fully against the virus and therefore we need new markers to guide our therapies. Say for instance, I think that one of the hot topics in the field right now is how the quantitations of a certain xenogen can help to guide the therapy. Now, if for the current therapies s0 conversion is still very low, I think the most significant difference that has an impact on treatments is related to interferon-based therapy and that is PEG interferon alfa-2a and 2b. Now, I think that research has to be focused so that we can further improve our s0 conversion rate in these patients to practically induce a cure to patients with chronic hepatitis B infection.

Hepatology Digest: You’ve just mentioned PEG-related interferon treatment. Specifically for patients in the Asia Pacific or China, how does that fit into the treatment plan of hepatitis B specifically for this region?

Pro. Lau: First of all, I think it is a misnomer that the Chinese, because most of the infections are vertically transmitted or maternal-fetal transmitted, that they do not respond well to the interferon based therapies. Based on the Phase 3 registration trials with the PEG interferons alfa-2a, it has clearly been shown to be an effective agent in terms of inductions of fully 0 conversions and disease remission in a substantial proportion of patients with chronic hepatitis B infections. Now the question is, how are we going to further select patients who will benefit more from the course of therapy, which is sometimes expensive and also at risk of certain side effects. A lot of pharmaceutical ergonomic activities and immunogenetics need to come into place so we can predict which patients will benefit more. Also parameters for monitoring the viral response as antigen quantitations might help us to determine whether we should continue the form of therapies of certain patients before we decide it is fruitless or fruitful.

Hepatology Digest: What about combination treatment in hepatitis B patients? Can you give an introduction into the present situation as far as combination therapy is concerned?

Pro.Lau: Personally, I believe in combination therapy...