EASL专访丨秘书长Thomas Berg教授：全球热议乙肝治愈新发现，共谋肝炎消除策略- 大数跨境

EASL专访丨秘书长Thomas Berg教授：全球热议乙肝治愈新发现，共谋肝炎消除策略

国际肝病

2022-06-30

导读：2022年6月22～26日，第57届欧洲肝病研究学会年会（EASL2022）暨2022年国际肝脏大会™（ILC 2022）于英国伦敦以线下同步线上的形式成功举行。

2022年6月22～26日，第57届欧洲肝病研究学会年会（EASL2022）暨2022年国际肝脏大会™（ILC 2022）于英国伦敦以线下同步线上的形式成功举行。这是COVID-19大流行以来，EASL年会首次回归线下，备受瞩目。《国际肝病》团队亲赴现场，并有幸邀请到EASL秘书长、德国莱比锡大学的肝病学家Thomas Berg教授为我们介绍大会盛况和亮点，同时分享本届会议给我们带来的肝病学领域，特别是病毒性肝炎方向的新发现。

《国际肝病》

您作为EASL现任秘书长，请介绍一下本届会议的盛况和亮点？

Thomas Berg教授

自COVID-19大流行以来，两年多过去了，这还是我们第一次面对面举办国际肝脏大会。首先，我真的很自豪我们有近7000名与会者和超过5500名在线参与者，我们通过EASL-ILC 2022数字扩展平台向外部社团提供服务。其次，我们尝试为展示研究的壁报和互动留出更多空间，我认为这是同样重要的。我们在会上集中介绍了有关病毒性肝炎、非酒精性脂肪肝疾病的几个相关且非常重要的新发现，以及关于罕见肝病和肝癌的非常有趣的数据。

英文原文：（上下滑动查看更多）

<Hepatology Digest>：As the secretary general of the conference, would you please introduce to us about the scale of this year's conference，and from the setting of the conference, would you please tell us what are the features and highlights which impress you very much?

Prof. Berg：First of all, as you know, since the start of the COVID pandemic nearly three years ago, this is the first international liver meeting we have been able to hold in person. First of all, I am really very proud that there is so much interest in that we have nearly 7000 attendees and more than 5500 online, and that we can conserve the external community by a digital extension of EASL-ILC 2022. I think it is also important that we try to have more space for posters and interactions showing research. I will show you in a minute several relevant and very important new findings coming up with respect to viral hepatitis, non-alcoholic fatty liver disease, but also quite interesting data on rare liver diseases and liver cancer.

《国际肝病》

请您谈谈乙型肝炎现阶段的治疗目标、新药研究进展，以及未来研究重点。

Thomas Berg教授

关于乙型肝炎，我们都以治愈为目标。目前，治愈的定义是HBsAg消失。有非常新颖的抗病毒药物正在研究中，我们在这里看到了有趣的siRNA和反义核苷酸数据，以及非常有趣的治疗结束数据显示高达30%的HBsAg无法检测到。但在另一项研究中，随访后评估表明达到HBsAg消失并不容易，所以我们需要更多的长期随访数据。我们是否过于雄心勃勃地希望在抗病毒治疗24或48周以及很短的随访时间内实现HBsAg消失，这是一个很大的问题；以及是否需要延长治疗或延长随访才能真正展示这些新药的全部潜力。当然，随着我们对乙型肝炎免疫学的深入了解，一个大问题是我们是否可以干预和刺激免疫系统。

英文原文：（上下滑动查看更多）

<Hepatology Digest>：What is the current progress in the research and development of relevant new drugs and the exploration of new treatment options? What do you think will be the focus or trend of future research?

Prof. Berg：With respect to hepatitis B, we all aim for cure. Currently, the definition of cure is loss of HBsAg. There are very interesting antiviral drugs being evaluated, and we have seen interesting data here with siRNA, with anti-sense nucleotides, and very interesting end-of-treatment data showing up to 30% HBsAg being undetectable, and in another study, after follow-up evaluation, where it has been shown that it is not so easy to reach HBsAg loss. So we need more long-term follow-up data, and it is a big question whether we are too ambitious with the wish to achieve HBsAg loss after 24 or 48 weeks of antiviral treatment and with a very short follow-up; and whether either extended treatment or extended follow-up is needed to really show the full potential of these new drugs. Of course, a big question, with a better understanding of the immunology of hepatitis B, is whether we can interfere with and stimulate the immune system.

《国际肝病》

您认为基于现有抗病毒治疗药物和方案能否实现HBsAg清除？

Thomas Berg教授

正如我前面提到的，可以实现HBsAg清除，但我们目前看到的可能性是，使用目前的治疗方案，我们不会实现高HBsAg消失率，至少在停止治疗后仅观察24周是不会的。正如我所提到的，可能有一些患者我们看到了令人鼓舞的数据，尽管他们可能没有实现HBsAg消失，但治疗后24周的HBsAg水平变得非常低（<100 IU/ml）。对这些患者进行更长时间的随访确实非常有意义，并且持续观察他们是否会出现HBsAg进一步降低，然后HBsAg消失。

英文原文：（上下滑动查看更多）

<Hepatology Digest>：Do you think the current antiviral therapy can achieve HBsAg clearance? What are the developments in biomarker predictors about HBsAg clearance? What further research will we do next?

Prof. Berg：As I mentioned before, HBsAg clearance can be achieved, but what we have seen so far is the likelihood that, with the current treatment regimens, we will not achieve a high rate of HBsAg loss, at least, not if we look only 24 weeks after stopping treatment. As I mentioned, there may be some patients for whom we have seen encouraging data, who although they may not have lost HBsAg, the level of HBsAg 24 weeks after treatment becomes very low (<100 IU/ml). It really will be very interesting to have a longer follow-up of these patients, and with ongoing observation, whether they will see further reduction in HBsAg, and then HBsAg loss.

《国际肝病》

请您谈谈目前全球消除丙型肝炎作为公共威胁的进展，以及重点和难点。

Thomas Berg教授

在世界范围内，我们未能实现世界卫生组织（WHO）提出的将丙型肝炎病毒新发感染率降低90%的目标。部分国家较为先进，已采取了良好的措施实施肝炎病毒感染的早期筛查，特别是丙型肝炎，但许多国家仍然缺乏这样的措施。

我们已经看到了有关如何改进以实现WHO目标的最新数据，我仍然认为微消除的概念（针对新发感染率最高的地区）可能是一个非常好的方法。英国有一项有趣的研究，他们对监狱中的服刑人员进行筛查，对检测结果呈阳性者随即开始治疗。发现感染率最高的人群并立即开始治疗，以防止病毒进一步传播，同时显著降低新发感染率，这也许是一个可行的方向。

然后第二步，较为困难，是在普通人群中发现HCV感染者。在这里，我们需要在初级保健医师层面进行广泛的ALT和丙型肝炎检测筛查。我们学到了很多关于COVID情况下的早期检测和现场检测的知识，所以为什么不将其中的一些方法用于发现病毒性肝炎患者呢。

英文原文：（上下滑动查看更多）

<Hepatology Digest>：Would you please share the current progress in the global elimination of hepatitis C? And screening is the first step to eliminate hepatitis C, so could you please talk about the key points and difficulties of hepatitis C screening based on clinical practice.

Prof. Berg：Worldwide, we are not on track with the WHO aim of achieving a 90% reduction in the incidence of hepatitis C virus infection. Some countries are more advanced. Some countries have taken good measures to implement early screening for hepatitis viral infection, particularly hepatitis C, but still in many countries it is lacking.

We have seen interesting data on how we can improve on achieving these WHO goals, and I still think the concept of micro-elimination (targeting the fields where the highest rates of new infection take place) could be a very good approach. There is an interesting study here from the UK where they screened people in prisons, and when they were detected as positive, they were treated immediately. Perhaps, this is the way forward in those situations where you find the highest prevalence of people being infected and starting treatment immediately in order to prevent further transmission of the virus, and significantly reduce the incidence rate of new infection.

Then the second step (and this is more difficult) is finding these cases in the general population. Here we need broad screening with ALT and hepatitis C tests at the primary care physician level. We learnt a lot about early testing and onsite testing with the COVID situation, so why not implement some of these ideas in order to find people with viral hepatitis.

《国际肝病》

最后，您想对未能来参会的《国际肝病》中国读者说些什么呢？

Thomas Berg教授

很遗憾，有很多来自世界各地的好朋友和 EASL成员，尤其是来自亚太地区、拉丁美洲和中东地区的成员，因为与COVID有关的旅行限制而无法亲身参会，我们非常想念他们。我可以告诉你的是，我们有数字扩展平台，所以你可以加入EASL学院网站，你可以加入大会，从现在开始接下来的六个月，你可以访问肝脏会议的所有内容。我想鼓励大家加入我们。我们将有一个新的会员策略，学员费用更低，然后您可以以非常合理的价格访问全部内容。因此，请加入EASL大家庭并成为会员。

英文原文：（上下滑动查看更多）

<Hepatology Digest>：The Hepatology Digest audience is Chinese hepatologists, and they cannot be here at the meeting. If you could address them, what words of encouragement would you share with them?

Prof. Berg：Yes. We are very sorry that we are missing very good friends and members of EASL from around the world, especially from the Asia-Pacific region, also Latin America, and the Middle East, that could not come, most of them because of the travel restrictions related to COVID. What I can tell you is that we have the digital extension, so you can join the EASL website on campus, you can join the Congress, and from now for the next six months, you can access all the content from the liver meeting. I would like to encourage everyone to become a member. We will have a new member strategy with lower fees for trainees, and then you can access the whole content for a very reasonable price. So please join the EASL family and become a member.