The Japan
GastroenterologicalEndoscopy Society

The Japan
Society for
Portal Hypertension

The Japan
Society of
Hepatology

The JapaneseLiver Transplantation
Society

The Japanese Societyof Gastroenterological
SurgeryTokyo

The JapaneseSociety of
Gastroenterology

The LiverCancer Study
Group of JapanThe Organizationof JDDWSUNDAY, 21 February 2016

InsideReality or Dream: to Eradicate
Hepatitis C and Hepatitis B

04

Barriers of HCV Treatment in the
Asian Pacific Region05

Different Role of Liver Biopsy between
Hepatitis B and C
06
Unmet Need for the Patients with
Chronic Hepatitis C
07
HCV Therapy - One Treatment for All Patient
Populations with HCV Infection		
08

Today
7℃
16℃
Produced by:
HEPATOLOGY DIGEST
www.ihepa.com:8088/pc/41/
special/index.html

Editor-in-chief: Hui Zhuang

国际肝病公众微信
订阅号：ihepatology

国际肝病公众微信
服务号：ihepa-S

国际肝病手机网m.ihepa.com

iPad 电子报刊
App 下载地址

2016daily1ok1.indd 1

Address from Imperial Highness
Princess Tomohito of Mikasa

It gives me great pleasure that the 25th General Assembly of the Asian Pacific Association for the Study of
the Liver (APASL) is being held for the first time in our capitol city of Tokyo, following Fukuoka in 2000 and
Kyoto in 2007.
It is my hope that this meeting of 4000 researchers from 60 countries specializing in the treatments of liverdisease under the main theme of Modern Hepatology, will take this opportunity to discuss and deliberate, fromall angles from fundamental to clinical studies, a permanent cure for the liver disease.
As you well know, it is said that 75% of all liver disease ailments are found in Asia. I am very proud andgrateful to APASL which is based here, together with AASLD of the United States and EASL of Europe, fortheir tireless efforts in the treatment and research of liver disease.
It was 30 years ago that a prominent medical doctor whom I highly respected said, of the many academic fields,
the medical field is the only one not explicated. In the midst of research into diagnosis and treatment of illnesses,
it is best, I believe, for individuals to be responsible and attentive to their own health. However, I truly feel thatmodern science and advanced technology and research, year after year, progress from one year to the next, in the
span of two years, five years, have progressively made way to explicated diagnosis and treatments of diseases.
It is my hope that your research results will find hope and shed light to patients who are suffering and to show
them a path to new life, and to prove to them that dreams can come true. My expectations from your studies andresearch are very high so that it will give strength to the patients. The patients, too, have high expectation fromyour research. I hope that you will be able to respond to their expectations. I am certain that your tireless efforts
toward your research and studies and progressive results will give light and the will to live for these patients.
My dear Professor Omata, thank you for inviting me to address this meeting. I am grateful for thisopportunity to meet with you all. I wish you all the best for a fruitful and successful meeting.

16/2/19 下午5:17

T

Masao Omata

Welcome Message

he Asian Pacific Association for the Study of the Liver (APASL) is one of the world's largest academic
associations for Hepatology, founded in August 1978 (38 years ago) by Profs K Okuda and L Powell (Australia).
Originally, the APASL meeting was held biannually with hundreds of participants to discuss diagnosis and treatmentof liver diseases including hepatitis, cirrhosis and hepatocellular carcinoma, more or less in closed manner.
However, the Asian Pacific region has the biggest number of patients, three-quarters of the world's total, sufferingfrom liver diseases including Chronic Hepatitis, Cirrhosis and Hepatocellular Carcinoma due to HBV (Hepatitis B
Virus) and HCV (Hepatitis C Virus) infections.
Because of the urgent and expansive need to offer better quality medical care for patients suffering from liverdisease in Asia, and through the initiatives of Prof Shiv K. Sarin (India), myself and other leaders in this region, now,
the APASL meeting has become an annual conference with more than 4000 experts from over 80 countries joining themeeting every year for the last 10 years.
Our organization also holds the Single Topic Conference (300-1100 participants each time) two to four times a year,with venues rotating all over in Asia, the last one at New Delhi in December, and publishes the international journal"Hepatology International" six times a year for education purposes.
The APASL Secretariat, located in Tokyo, also constantly provides up-to-date information through websites and
E-News.
It is estimated that 75% of the world's liver patients exist in the Asian region. Based on this, in cooperation withAASLD (the American organization) and EASL (the European organization), APASL is a central academic society
which plays a key role in treatment and the research of liver diseases throughout the world.
This Tokyo meeting will be the 25th APASL Annual Meeting, and will be held at the International Convention
Center Pamir, Grand Prince Hotel New Takanawa from Feb 20 to 24, 2016. Previously, this meeting was held in Kyoto
in 2007, but this is the first time Tokyo has hosted this annual gathering.
Under the theme of "Modern Hepatology", and under the President, Prof Osamu Yokosuka, the conference program
was planned to contain up-to-date information and cutting edge lectures by eminent researchers, and to share state-ofthe-art views and experiences regarding liver diseases towards the complete cure of liver diseases.
We believe and hope this meeting will help patients suffering most in Asia.
Masao Omata
Honorary President, The 25th Conference of the
Asian Pacific Association for the Study of the Liver

Welcome Message

D

Osamu Yokosuka

ear Colleagues, It is a great pleasure for us to invite you to the 25th Asian Pacific Association for the Study of theLiver (APASL 2016) that will be held on February 20-24, 2016 in Tokyo, Japan. We are delighted to welcome
you to the cultural, historical and scenic metropolis of Tokyo.
Under the theme of “Modern Hepatology”, the conference program will perform high quality content with full of
maximum up-to-date information and cutting edge lectures by eminent researchers, to show mature, time-honored,
well-established explanation of Hepatology in order to reconfirm their significance by scientists and clinicians for theachievement of better both basic and clinical practice.
The conference aims to raise awareness of the current status and future prospects to develop a better understandingof the roles, objectives and operations of the various institutions, academics, companies, associations, non-profit
organizations, and other related sectors, to enhance communication and collaboration within all of us, and to deliver
mutual benefits to the people in the Asian Pacific region, where liver disease has been one of the most common andserious problems.
As more than 4,000 delegates of experts from all over the world, more than 60 countries are expected to attend thisAsian Pacific’s largest liver conference, we are sure that this is the perfect opportunity for those of us in the Asian
Pacific region to share state-of-the-art views, values, experiences and practices regarding liver diseases, such as Viral
Hepatitis, Liver Cancer, NASH, Liver Failure and other topics.
We are looking forward to welcoming you to Tokyo.
With warmest regards,
Osamu Yokosuka, MD., PhD.
President, The 25th Conference of the Asian Pacific Association for the Study of the Liver
Professor, Department of Gastroenterology and Nephrology, Chiba University Graduate School of Medicine

2

2016daily1ok1.indd 2

16/2/19 下午5:17

I

Welcome Message

t is a matter of great pleasure that the Asian Pacific Association for the Study of the Liver (APASL) is holding its
25th meeting this year in Tokyo, Japan from February 20-24, 2016. It is a mattter of great pride for all of us that the
Association and its Journal, the ‘Hepatology International’, have become symbols of excellence in liver diseases not
only in Asia, but in the world. Liver diseases are more common in the Asian region and over the years, the clinicians
and scientists from this region have given new protocols and science to the world.
It is in this context, the theme of the APASL 2016, “Modern Hepatology” is most befitting. The scientific committee
needs to be congratulated for developing a very high quality program. The recent developments in each area are being
covered by eminent hepatologists and researchers from all over the world.
More than 4,000 delegates from all over the world, from more than 60 countries, are expected to attend thisAsian Pacific’s largest liver conference. I believe that it would be a unique opportunity to learn from each other. I am
delighted to note that special encouragement is being given to young investigators and basic researchers.
The Land of the Rising Sun, Japan, leads also in the tradition of hospitality and warmth. I am sure that the untiring
efforts of the organizing teams under Prof. Yokosuka’s dynamic leadership and Prof. Omata’s patronage, would
provide you with the most comprehensive and enjoyable academic event in the history of APASL.
On behalf of all the memebrs of the Steering Committee, I feel privileged to extend our full support and best wishes
for a most successful and memorable APASL 2016.
Shiv Kumar Sarin
Chairman
Steering Committee, APASLI

Shiv Kumar Sarin

Welcome Message

am very pleased with Osamu Yokosuka, who is the President of this meeting, to be able to hold the 25th Asian
Pacific Association for the Study of the Liver (APASL 2016) in Japan.
Looking back at previous APASL meetings in Japan, it was held in 2000 in Fukuoka by Dr Michitami Yano who is
my teacher and it was held in Kyoto in 2007 by Prof. Masao Omata. We were able to be held in Tokyo to give a time of
8 years to give a cooperation of the member to be in this society.
We have gathered more than 1500 abstracts and presentations, the contents of which seems fresh and interesting andscholarly presentations have been prepared.
APASL is the largest of the hepatology societies of the Asia Pacific region, but has positioned itself as a very
important society academically. It is also an important place to understand the liver disease patients and hepatology ineach of the countries in the region.
Tokyo will host the Olympic Games in 2020, and the Japanese government and the Tokyo Metropolitan Governmentis already working on the preparation. Culturally, Tokyo also offers a charming city of food, fashion and architecture.
I am looking forward to seeing you and everyone in fascinating Tokyo.
Hiroshi Yatsuhashi
Vice President, The 25th Conference of the
Asian Pacific Association for the Study of the Liver

Hiroshi Yatsuhashi

What to Watch Out for Today
Room 1ABCD 		

09:00 - 09:30		Opening Ceremony

Symposium 1. Barriers of HCV Treatment in Asian PacificRoom 1ABCD

09:30 - 09:50

Three Decades of Advances in Nucleotide Antivirals: from Research to Expanding Access			
Room 1ABCD

09:50 - 10:10

John C. Martin
Barriers of HCV Treatment in Asia Pacific

Masao Omata

APASL HCV and Transplantation

Geoffrey McCaughan

Symposium 2. APASL Guideline in HCV Treatment
Room 1ABCD

14:15 - 14:35

Symposium 3. HCV Treatment in Special Situation
Room 1ABCD

15:50 - 16:10

Unmet Need for the Patients with Chronic Hepatitis C

Michael P. Manns

Room 1ABCD

16:10 - 16:30

Clinical Outcomes of Anti Hepatitis C Therapy

Massimo Colombo

Room 1ABCD

16:30 - 16:50

Challenges and Prospects of HCV Therapy Beyond the DAAs

T. Jake Liang3

2016daily1ok1.indd 3

16/2/19 下午5:17

Reality or Dream: to Eradicate Hepatitis C and Hepatitis B
population in Egypt is hepatitis C positive

population related to HCV. Even whenfibrosis to regress over time. When theobtained drug (a nucleotide polymerase

are going to have a significant component

fibrosis is removed, there is no new

and disproportionately genotype 4. They

inhibitor, sofosbuvir) at a much-reduced
cost from one of the major manufacturers,
Gilead. The cost of the course of thenucleotide polymerase inhibitor from

Gilead for the patients in Egypt was $900.

They coupled that with an NS5A inhibitor
made by a company in San Francisco

called Presidio. It is not licensed for use

in the United States but now Egyptian

Eugene R. Schiff"It has been estimated thatonce treatment programs
get going, it will probably
be thirty years and you
could eradicate thisdisease."Since almost all HCV infections

could be cured by currently available oral

direct-acting antivirals, could we expect

an opportunity for the eradication of HCV

worldwide? In an interview with APASL
Daily, Professor Eugene R. Schiff, Schiff

Center for Liver Diseases, University ofMiami Miller School of Medicine, Miami,

USA told us that we could expect theeradication of HCV but it would be overa thirty-year period. Because there is novaccine for hepatitis C, it would meaninterests own a significant proportion of
the company. It is now been administeredvery effectively in Egypt. That program

may well come close to eliminating HCV
in Egypt over the next five or six years.

Prof. Schiff said, "In general, weare going to start to see more people
being diagnosed and more people being
treated. In some of these countries, drugs

that are not licensed in the United States
are being used that might be considered“counterfeit”, but if they are effective
and safe then fine. .I think we will see

these drugs become much more widely
available and more affordable. The talk I
am giving at APASL is related to this inpart. In Japan, one of the most common
liver diseases is chronic hepatitis C. It

is disproportionately genotype 1b. Now
that these drugs are available, they are
producing cure rates >95% on finite
therapy. "are a lot of things that are being developed"Even when the curesfor hepatitis C increase,
they are going to have asignificant component ofpatients who will need to
be followed because of theadvanced liver disease andcirrhosis that gives rise to
hepatocellular carcinoma
despite the eradication of
HCV."

One is called point-of-care testing. The

However, the question there might

treating everyone. Of course we can neverget rid of every last case but we could get
it where it is really very well contained.

Something that is analogous to that waspolio and the polio vaccine.

Eradication of HCV would be

dependent for the large part on access:access to someone who is going to test
and that means getting to a facility orservice; and access to the drugs, which islimited by cost.

As far as access to a diagnosis, therethat may have a place in facilitating this.
other issue is the access to the drug andthat is variable. There are regions thatare being used to demonstrate that HCV
can be eradicated from that region where

the resources do not otherwise exist.
Prof. Schiff gave 3 examples of suchregions - Egypt, the country of Georgia
and Mongolia. For example, 15% of thebe, what is the future of hepatology
going to be because a large part of thediscipline currently focuses on hepatitis

C? If we start with HCV itself, we know

the cures for hepatitis C increase, theyof patients who will need to be followed

because of the advanced liver disease andcirrhosis that gives rise to hepatocellular

carcinoma despite the eradication of
HCV. Where there is advanced cirrhosis,
the complications of cirrhosis need tobe managed even though the underlying
cause has been stopped.

" The problem with HBVis that, unlike what we seewith HCV, in the majorityof cases, therapy is not
finite."When asked about the future oftreatment of hepatitis B, Prof. Schiffthought it was particularly relevant
to Asia. The predominant hepatitis inSouth-east Asia or sub-Sahara Africa

underlying inflammation that causes
fibrosis and there will be regression ofexisting fibrosis. The problem with HBVis that, unlike what we see with HCV, inthe majority of cases, therapy is not finite.
Even though the medications we have arevery effective in stopping the progression
to cirrhosis and reducing the risk forcancer of the liver, they have to be given
continuously. When therapy is stopped, inmost cases, it recurs. HCV can be cured

with finite treatment, but that is not true
with HBV in the vast majority of cases.

" The point is that for HBV,
the new advance will be toaccomplish finite therapy- to be able to give it for agiven period of time and toachieve cure. "is HBV. In those regions in particular,

HBV has been transmitted in the pastfrom mother to newborn (perinatal orvertical transmission). Right now, there
is underway around the world, universal

vaccination against hepatitis B. There is along way to go in some of these countries
particularly in Africa, but when the

newborn is vaccinated against HBV, eventhough the mother is positive, infection in
the infant can be prevented.

For those already with hepatitis B,

treatment has come a long way. There

are some similarities with HCV in thatthese are very effective pills. The first-

line drugs are nucleotide and nucleosideanalogs (entecavir and tenofovir from
Bristol-Meyers Squibb and Gilead

respectively). These pills can render aperson with HBV negative for virus in
their blood (i.e. HBV DNA-negative)

and that returns liver chemistry to normal

and histology reversal just as with HCV.

Where there is fibrosis without advanced
cirrhosis, removing the virus allows the

To Prof Schiff, the challenge forhepatology in the field of HBV is to

produce drugs that will get rid of cccDNA
from the nuclei of infected liver cells.
Currently, giving medication gets rid of
the virus circulating in the blood, but
because of the cccDNA in the nuclei ofthe liver cells, when therapy is stopped,
the virus can begin replicating again. In
people who appear to have recoveredfrom HBV, even where HBsAg-negative,

the cccDNA will persist in the core
nuclei so if immunosuppression occurs

with drugs like rituximab for example,
HBV will be reactivated. The point isthat for HBV, the new advance will beto accomplish finite therapy - to be able
to give it for a given period of time andto achieve cure. We cannot do that now.
We can achieve some good outcomes, but

we can’t cure it. Because patients needto stay on therapy indefinitely, cost andcompliance come into play. The promising
drugs are those that are focusing on
cccDNA, but they are not there yet.

Want to know more about future
perspectives in hepatology? Let's meetwith Professor Schiff for his speech on
23rd Feburary, in Room 1BC.

(particularly in Japan where the epidemic

started well before that in the UnitedStates) that there is significantly morecirrhosis and cancer of the liver in their

4

2016daily1ok1.indd 4

16/2/19 下午5:17

Barriers of HCV Treatment in the Asian Pacific Region
disease and because there are nopatients infected with HCV and having

at a very late stage. When patients had

prognosis was very poor. The introduction

symptoms, patients come to the clinic
jaundice, bleeding appeared." Says Dr.
Masau Omata.

"So the screening, or inefficient

screening could be a barrier too", stresses
Dr Omata.

Advances in Nucleotide
Antivirals"The recent introduction of avariety of DAA agents makes HCV curepossible for a majority of patients andis stimulating the design of elimination
strategies for particular genotypes andgeographies."

Direct viral polymerase inhibitors,

treatment world of HCV. It is a highly

effective, well-tolerated, once-a-day oral
drug with a minimal resistance profile.

Not only has SOF worked well in

combination with interferon, ribavirin andother DAA agents, but it has also beenformulated with ledipasvir for a single pill
treatment regimen.

According to Dr. John C. Martin,"As of September 2015, over 600,000
HCV infected patients have initiatedtreatment with SOF-containing regimens".

The key to solving the accessibility

issue was to follow the precedent of TDF,
to implement a generic access program.

45 years experience"Recent and remarkable progress innucleoside analogues, such as

the development of oral drugs has made it

and zidovudine(HIV) have been the

all of my patients."

these early generation nucleosideworldwide suffering liver diseases is ineffects and were not tolerated well, they

include Chronic Hepatitis, Cirrhosis andaround the world.

(Hepatitis B Virus) and HCV (Hepatitis C

acyclovir(HSV, VZV), gancyclovir(CMV)

possible to eradicate HCV infection frommainstay of antiviral therapy. Although

The biggest patient population

analogues brought some significant side

Asian Pacific regions. These diseases

prolonged the lives of many patients

Hepatocellular Carcinoma due to HBVFor thirty years, nucleotides suchas tenofovir DF (TDF) have been theVirus) infections.

Although, Some Asian countries

predominant agent for chronic therapy

have more patients suffering from HBVpercent of HIV patients, close to one

Japan has a very different demographicof HIV and hepatitis B infection. Eighty

related disorders, whereas a country likemillion in total, have been treated withand clinical feature whereby 70-80%

patients have received TDF-containing

related.

ease of accessibility.

drugs) can be the barrier in the Asian-

TDF in Western countries, and 8 millionof hepatocellular carcinomas are HCV-

regimens in developing countries, due to"Of course the cost (of the new

Pacific region. But it is an insidious

outcome.

As shown by the results ofChild B or C cirrhosis treated by LDV"More than 200,000 new cases ofanalogue sofosbuvir(SOF) has rocked the

daclatasvir (DCV) has helped improve theAsia, based upon his experience for the

1% vs. 10 million in ChinaTs i m e p r e v i r, l e d i p a s v i r ( L D V ) a n d

SOLAR-1 and SOLAR-2 studies,

last 45 years.

In the last two years, the nucleotide

of DAAs, including sofosbuvir (SOF),

In this symposium, Dr. Omata willaddress the issues of HCV treatment inoday, four leading hepatologists
from US, Japan, China and India,
providing different perspectives, will
discuss the challenges facing theirfields in the Asia-Pacific region. Thissession is chaired by Dr Shiv K.
Sarin, and Drs John C. Martin, Lai
Wei and Masao Omata will also give
their insights on how to tackle HCV
infection.

decompensated cirrhosis were limited andgenotype 1/4 HCV infected patients with(SOF)+ribavirin(RBV) for 12-24 weeks,

575/627(92%) subjects achieved SVR12.
Of the 250 decompensated patients whoachieved SVR12, 60% (150) had an

HCV were reported to China CDC in

improvement in MELD scores. Similar

Compared to the higher prevalence

study and other studies. Although real life

infection rate in China has usually not

SVR is often associated with a significant

2013"

data was shown in the ELECTRON-2

rate of HBV infection, the 1% HCV

data demonstrates a higher relapse rate,

been paid as much attention as HBV. A

improvement in Child's and MELD score.

the general public have some knowledge

SOFO/Velpatasvir, Grazoprevir (MK-C u r r e n t l y, P e g - I n t e r f e r o n /regimens have shown an improved SVR

recent public survey found that only 1% ofNewer drug combinations, like

about HCV transmission and prevention.

5172)/Elbasvir (EBR) and Abbvie 3D

Ribavirin(Peg-IFN/RBV) is still thebut raised some safety concerns withstandard treatment regimen in China, withcertain regimens.

to clinical study results.

and effective in improving clinical statebarriers from patients, as well as fromby experts in patients with DC as thisside, lack of awareness, low treatment

often with high bilirubin and renal

SVR rate ranging from 44-83% according

Dr Sarin stresses that "though safe

According to Dr. Lai Wei, there are

and outcomes, the DAAS should be used

health providers. From the patients'group has a rapidly progressive disease,efficacy, and HCV treatment affordability

impairment."

and treatment compliance and adherence
all contribute to patients' long-term

commitment to treatment. The lack ofreferral to specialists is the physicians
barrier.

The high cost of the treatment, lowreimbursement for lab tests and limited

insurance may deter patients from

Symposium 1 Barriers of HCVTreatment in Asian Pacific
09:30 - 10:50
Room 1ABCD

commencing treatment

Because of the big population basein China, the 1% sero-prevalence means
there are 10 million individuals suffering
HCV infection, which is a strikingly big

figure. HCV should be a key focus in
China too.

Improved outcome of
Decompensated Cirrhosis"The introduction of DAAs,

including sofosbuvir (SOF), simeprevir,

ledipasvir (LDV) and daclatasvir (DCV)
has helped improve outcomes."

Before the introduction of DAAs,

the treatment protocols and options for5

2016daily1ok1.indd 5

16/2/19 下午5:17

Different Role of Liver Biopsy between
Hepatitis B and C
1

Hiroshi Yatsuhashi

A liver biopsy is needed
for the patients withchronic hepatitis B,
because it is difficult todecide prognosis andtreatment policy in thepatients whose complete
viral clearance is difficult.

APASL Daily: The first time the
APASL conference came to Japanwas in 2000 in Fukuoka with yourteacher, Dr. Michitami Yano, as the
President. Now it's the third time
APASL has been held in Japan andthe former student has today become
the Vice-president and committee
member. What's your feeling about thedevelopment of APASL, also about
the development of hepatology inJapan?

Prof. Yatsuhashi: As there are manyviral hepatitis patients present in the
Asian region, I perform clinical workand research of viral hepatitis under theguidance of Dr. Yano who is a my teacher.
I have a great interest in the epidemiology,
patients background, natural course andanti-viral effect. I have a great interest inwhat are the differences and similarities
between Japan and Asian countries. I amvery pleased that we have been able tohold this third APASL in Japan.

2

APASL Daily: N o n - i n v a s i v ediagnosis of liver fibrosis has been
widely used in these years. Do we stillneed liver biopsy to stage and scorethe disease in liver? When is a liverbiopsy unavoidable in your opinion?

Prof. Yatsuhashi: Non-invasive
examination of the liver such as FibroScan
or several kinds of simple blood tests (FIB4, APRI-score and M2BPGi etc.) are usedin Japan. Among such circumstances, I also
think that liver biopsy is needed for thepatients with AIH, PBC or NASH becausesuch liver disease needs histologicalfindings as diagnostic criteria. However, I
have a special thought with respect to thehepatitis B. I think a liver biopsy is needed
for the patients with chronic hepatitis B,
because it is difficult to decide prognosis
and treatment policy in the patients whose
complete viral clearance is difficult. In
contrast, the significance of liver biopsy
is becoming smaller in chronic hepatitis C
patients due to the viral clearance that canbe achieved these days.

3

APASL Daily: Standardization will be helpful and perhaps
is necessary to improve the diagnostic performance of
non-invasive diagnostic methods. But the related guidelines
seem scarce. Will APASL develop a guideline on noninvasive
diagnosis?

Prof. Yatsuhashi: I feel there may be difficulty in establishingguidelines on noninvasive diagnosis in APASL at this time. This
is not just limited to guidelines on non-invasive diagnosis because
across medical care, economics, society and culture, there is a large
variation across the Asia-Pacific countries. The features of the AsiaPacific countries is that they have a diversity that is not uniform. By
to develop with future work through APASL, consensus among thecountries with such diversity will be established in the near future.

4

APASL Daily: You're very famous for research on the various
types of hepatitis. Which kind of hepatitis is the gravest inJapan now?
Prof. Yatsuhashi: Among the five types of hepatitis virus,
hepatitis C virus has the strongest impact in Japan. It is apparent thatliver cancer as the terminal stage of liver disease is closely associatedwith hepatitis C infection in Japan. Future interest in liver disease inJapan may move from hepatitis C to hepatitis B.

5

APASL Daily: HBV genotypes differ in their clinicalmanifestations and responses to therapy. The Japanese havebeen infected with genotypes B and C mainly. However, an
article published in J Gastroenterol Hepatol by you and yourcolleagues mentioned that the distribution of genotype A had
also increased. Will current therapy need adjustments?
Prof. Yatsuhashi: Indeed, the main genotypes of hepatitis B
virus in Japan are genotype B and C until now. As we have reported in
GUT 2011, genotype A infection is increasing in Japan. This is due toglobalization. This phenomenon is expected to further accelerate. Of
course, I also think that it is necessary that treatment guidelines adapt inJapan to the presence of genotype A.

P ro f e s s o r
Hiroshi Yatsuhashi, Vice-president of
APASL 2016, Nagasaki Medical Center, Japan, will
give two lectures at APASL2016: i. ”Various Hepatitis
in Japan” on 22nd, Feburary,and ii.”Non-Invasive
Diagnosis of Fibrosis: APASL Clinical PracticeGuidelines
and Future Directions”.

6

2016daily1ok1.indd 6

16/2/19 下午5:17

Unmet Need for the Patients with
Chronic Hepatitis C

Michael P. Manns
Professor Michael P. Manns,
Department of Gastroenterology,
Hepatology and Endocrinology,
Hannover Medical School, Germany,is scheduled to speak on the Unmet
Need for the Patients with Chronic
Hepatitis C-including genotype 3,
DAA resistance, HCV recurrent posttransplantation, decompensated liverdisease and renal insufficiency, etc.
Therapy for chronic hepatitis
C virus (HCV) infection has been
revolutionized due to interferonfree, all-oral combinations withdirect acting antiviral agents(DAA) targeting the HCV protease,polymerase and NS5A protein.

Sustained virological response(SVR) rates of more than 90 % for
most HCV patients have become areality and these results have been
confirmed in real life experiences.
The average treatment duration is
12 weeks. For some difficult-to-treat
patients, 24 weeks seem necessary,
while 8 weeks is sufficient fortreatment naive, non-cirrhotic HCV
genotype 1 patients with viral load
< 6 MIO IU/ml with sofosbuvir(SOF) plus ledipasvir (LDV). Even
shorter durations are presently
being explored for future regimens.
Preliminary results suggest that
6 weeks may become possible
at least for easy to treat patients.
While this seems to be the limit forchronic HCV patients, 4 weeks seemrealistic for acute HCV.
HCV genotype 3 patients are
now the most difficult to treat
population. In particular for cirrhotic
and treatment-experienced patients,a n e ff e c t i v e a n d s a f e 1 2 w e e kregimen is still needed.
Preexistent NS5A mutants
indicate a significant risk fortreatment failure and they persist
long term after treatment cessation.
The relevance of viral resistance

Don't Miss Tomorrow

has to be studied further in DAA
failure patients that are a very
heterogeneous group. Neverthess,pretreatment routine testing forresistance-associated variants (RAV)
seems to not be necessary for the
average HCV patient.
Wi t h t h e a d v e n t o f D A A
therapies, prevention of recurrent
HCV infection after livertransplantation has become possible.
If patients achieve SVR before
transplantation or are at least 30
days negative while under therapy,
HCV recurrence is prevented.
Eradication of HCV infection in the
post-transplant population should beachieved soon in the years to comeand a decline of transplantations for
HCV induced liver disease should
happen within the next decade.
SOF based DAA therapies havealso been explored in decompensatedliver disease, i.e. Child B and C
cirrhosis. The majority of patients
improve their MELD and CPT
scores after achieving SVR.
However, there are a proportion ofpatients that do not improve or evendeteriorate. The definition of thepoint of no return is a major unmet
need and still an unsolved problem.

Renal insufficiency is another yet
unsolved problem in particular in thedecompensated patient since SOFbased regiments cannot be given
to patients with GFR< 30 ml/min.
On the other hand, the so-called 3D
combination (Paritasvir, Ombitasvir,
Dasabuvir) can be given to patientswith renal insufficiency but is either
not recommended or contraindicatedin decompensated liver disease.
Novel regimens are needed forpatients with decompensated liverdisease and renal insufficiency.
Whether SVR following successful
DAA therapies protects from de novo
infections at least in a proportion ofpatients also needs to be clarified.
But all the above issues might
be a piece of cake when comparedwith the last but the most important
unmet need: the global access to
HCV therapies. A global strategy for
HCV eradication is urgently needed.
Symposium
3: HCV Treatment in Special
Situation - "Unmet Need for the Patientswith Chronic Hepatitis C"
15:50-16:10
Room 1ABCD

08:45 - 09:00

Room 1BC 	

Presidential Lecture

09:00 - 10:30

Room 1BC 	

Presidential Plenary

09:00 - 10:20

Room 1A

Session 1. HBV Treatment in Various Countries

09:00 - 10:20

Room 1D

Session 2. Significance of HBV Markers for Clinical Use

09:00 - 10:00

Room 2

Session 3. Recent Progress in ALF

10:45 - 11:05

Room 1BC 	

Lecture 1. Hepatitis B Treatment

11:05 - 11:25 	Room 1BC 	

Lecture 2. Hepatitis B in EU

11:25 - 11:45

Room 1BC 	

Lecture 3. Serum HBsAg and AFP Levels during Acute Hepatitis Flare of Chronic		Hepatitis B: A New Look in the Natural Course and Antiviral Therapy

10:45 - 11:45 	

Room 1D

Session 4. Treatment Towards HBsAg Clearance

13:30 - 15:30

Room 1D

Session 5. Basis for Hepatitis Treatment

13:30 - 14:50

Room 1BC 	

Symposium 6. Novel Therapeutic Strategies for HBV

14:50 - 17:25

Room 1BC 	

Symposium 7. Treatment of HBV for a Cure

13:30 - 15:25

Room 2

ACLF Working Party MTC

15:45 - 17:05

Room 1A

Symposium 8. Reactivation and Occult Infection of HBV

15:45 - 17:25

Room 1D

Session 6. Novel Approach for Viral Research

7

2016daily1ok1.indd 7

16/2/19 下午5:17

One Treatment for All Patient Populations
with HCV Infection
Chronic hepatitis C virus (HCV)
infection is the main cause of cirrhosis
and hepatocellular carcinoma and it isestimated that more than 110 million
people are chronically infected with
HCV worldwide. Efficient antiviraltreatment can reduce the risk ofdeveloping liver complications,however, poor efficacy and tolerabilityof current antiviral therapies have
limited treatment uptake to <1%.
This afternoon, Professor Edward
Gane from Auckland Clinical Studies
Ltd., New Zealand will give alecture entitled “HCV Therapy-One
Treatment for all Populations”.
With more than 100 direct acting
antivirals (DAAs) having enteredclinical development, the era of new
DAAs has come. Recently, there
were three combinations, ledipasvir/
sofosbuvir, ombitasvir (ritonavirboosted)/paritaprevir plus dasabuvir
a n d e l b a s v i r / g r a z o p r e v i r, t h a tcompleted Phase III development that
could achieve sustained virologicalresponse (SVR) rates >95% inpatients with HCV genotype (GT)
1 infection, including cirrhotics andtreatment-experienced.
The oral pangenotypic regimen,
sofosbuvir plus pangenotypic NS5A
inhibitor velpatasvir for 12 weeks
was confirmed to be highly efficientwith an SVR of 95-100% in GT 1-6
HCV infected patients in the Phase III
ASTRAL studies. Using the next gen
NS5A inhibitor ABT-530 plus next
gen PI ABT-493 for 8-12 weeks in
the Phase II SURVEYOR studies, an
SVR of 94-100% could be achievedin patients with HCV GT 1, 2 or 3
chronic infection.
Now, DAA triplets are being
developed to shorten treatment
duration and salvage DAA failure
patients. In the small Phase II
L E P T O N s t u d y, s o f o s b u v i r /velpatasvir plus the pangenotypicprotease inhibitor GS-9857 for 8
weeks could achieve an SVR of
100% in HCV GT1 and GT 3 infectedpatients with cirrhosis. However,the SVR rates were lower in DAA
failures, suggesting that the treatment
duration should be prolonged for
Edward Gane
these patients. In another small
Phase II C-CREST study, 8 weeks ofcampaigns, global eradication ofgrazoprevir plus NUC NS5B inhibitor
HCV should be feasible within the
MK-3682 plus the next gen NS5A
next 50 years.
inhibitor MK-8508 could achieve
an SVR of 92% in patients
Symposiumwith HCV GT 1, 2 or 3
3: HCV Treatment in Special
infection.
Situation - "HCV Therapy-One Treatment
These pangenotypicfor All Populations"and ultrashort regimens
14:55 - 15:15
represent the final phase ofRoom 1ABCD
DAA development, with SVR
rates above 95% across all patient
populations. Combined with DAA
access programs, public awarenessand community-based targeted testing

An authoritativeinternational media
platform of hepatology

Linking China to the world of hepatology
Authorized publisher of Daily News for APASL 2009, 2010,2011, 2013 , 2014 and 2016
A multiform professional media
Hepatology Digest Newspaper
Hepatology Digest Website (www.ihepa.com)
Hepatology Digest Weibo (@ 国际肝病网 )Hepatology Digest WeChat (account: ihepatology)
E-mail: media@medcomax.com

国际肝病公众微信
订阅号：ihepatology

国际肝病公众微信
服务号：ihepa-S

国际肝病手机网m.ihepa.com

iPad 电子报刊
App 下载地址

8

2016daily1ok1.indd 8

16/2/19 下午5:17