Hello everyone. I'm Jia-Horng Kao. I'm now a chair professor of the Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine and also the Chief Division of Gastroenterology and the Hypertology Department of Internal Medicine, National Taiwan University Hospital. Hello everyone. I'm Dr. Tung-Hung Su from Department of Internal Medicine, National Taiwan University Hospital. Professor Kao, Taiwan plays a leading role in the research and management of chronic hepatitis B. For example, there's a universal vaccination programs. Would you please talk more, about the contribution of the research and management of chronic hepatitis B in Taiwan. Tung, thank you for having me in this interview. In Taiwan, our previous studies by our senior professors, show that the prevalence of HBV infection in Latino populations was as high as 20 percent. It was thought we may have a vaccine needed for HBV patients in Taiwan. Because of this high disease burden in Taiwan that the Taiwanese government and academia have done a lot of research in trying to understand the HBV infection in Taiwan. As you mentioned, the contribution of Taiwan to the research and the management of chronic hepatitis B, as seen, we can divide it into three aspects. The first one is you mentioned the universal hepatitis B vaccinations. When the hepatitis B vaccine was available in early 1980s, the Taiwan government decided to launch this universal hepatitis B vaccination program in Taiwan, trying to prevent the mother to child transmission, also called vertical transmissions. Since 1986, we had the first universal hepatitis B version program in the world. Nowadays, I've seen the prevalence of HBV carriage in our children has declined from 10 percent before vaccination and now to less than one percent after 30 years of vaccination program. The second is about the natural history of HBV infections. Previous study and now we can understand what the natural history of HBV infections. We can divide it into different phases. For example, immune-tolerance, and inactive carrier state, and also the reactivation phase, also called immune-active hepatitis B. Our recent studies in the National Taiwan University Hospital, we use some new biomarkers, for example, HBV DNA, surface energy, and the core-related antigen. We are trying to have risk specifications of our HBV patients. According to our previous studies, now we can have different risk level of our HBV patients. For those with a high risk of developing liver cancer, these patients should be treated earlier, and for those with the lowest risk or SEC, of course, we can only far-off and may then reassure these patients that they have a very low risk of SEC so they do not worry about the risk if they can have irregular follow-up. The third one is the management of HBV infection. Our study also show that for those with liver cirrhosis. I see we have published a paper. You're the first author [inaudible] a study where you wrote modern 1300 HBV cirrhosis patients and we treat them with the antivirus. After four years of follow up, I see we can reduce the risk of SEC for 60 percent and we also reduce the labor related mortality, or cause mortality and other cirrhotic complications. I think these are the contribution that Taiwan have done to the HBV research and also very great contributions. Thank you. Taiwan also has a very great healthcare system and high quality of medical care. Regarding this, would you please talk about the help of the National Health Insurance in Taiwan in the management of chronic hepatitis B? Yes. I think it is also important question. As my answer to the first question, the third part, that the NHI, National Health Insurance system because of disease burden also when we had the very good drugs such as interferon, the nucleoside analogues. We launched the first the hepatitis B treatment program, I think there are two or three. In the beginning we have interferon and some first-generation antivirus. Nowadays we have all kinds of drugs by including the latest generation, such as the emtricitabine and tenofovir TDF. By using the drug, as I just mentioned, we can reduce the risk of disease progression in hepatitis B patients, especially for cirrhosis cases. In addition to that, we can also see some new indications. The government and they are also trying to expand that treatment occasions. For [inaudible] patient they can fit lifelong and therefore epoxy patients, they can have treatment and [inaudible] loss of energies. For inactive patients, of course, they can only receive a three year of treatment. But I think we can discuss this issue further. For, highly viremic carrier models, as in the new indications is we can use some drugs for these highly very mothers trying to prevent the vertical transmission. Indeed have a good response for those patients, so I assume the national health insurance system, indeed, there have a lot to our HBV patients and we shall continue these directions to help more of our cases. Thank you. Currently we have a very successful HBV vaccination against Hepatitis B infection. Also, we have very potent anti-viral therapy against the virus. Do you think there is still some unmet need in the clinic, RSP management, or research? I think we can use that two different aspects for basic research and clinical research. I think I addressed the clinical unmet needs. I think the first of all is now the cirrhosis patients, they need lifelong therapy. In fact, in many international guidelines, for example, American guidelines, the European guidelines and they suggest the e policy or inactive page and they should have long-term or even lifelong therapy until they have a so-called functional cure. That is a loss of surface energies, but usually, in our clinical practice, this is a lifelong treatment. There's the most critical and many of Hepatitis B therapy not like the HBV treatment. Now we can use pan-genotypic [inaudible] only two to three months and we can cure ammonia 97 percent of our HBV patients so there's our tree. We can cure HBV by finite periods of therapy, so we need to develop a more potent drugs, perhaps with different modes of actions and some combination of therapy is also needed and then we can have HBV cure within a very short period of time. For basic research, I think the most important, we do not have good tacho system or animal models that we can test the drugs in vivo and in vitro systems. To have high throughput screening, to identify ways to actually be the best in class, then we can translate to our patients for clinical therapy. Thank you. Because chronic RSPs major disease burden in Taiwan and also around the world so that WHO said that goal to eradicate or control the virus by the year 2030. Would you please talk about the efforts that we need to do toward the eradication of chronic RSPs? Yeah, indeed a baby. Not a mission impossible is a mission may be possible. If we can do the following things. First of all, we should continue our universal hepatitis budgeting program, as in this is the most cost-effective way to control Hepatitis B virus, then we do not have new HBV cases in our community, in the society, and also in the word. The second one, for those who need antiviral therapy, we should give them the effective drugs right now, as I just mentioned, we now have a baby, a potent drugs with good safety profile and minimal risk of drug resistance. These patients care a long-term therapy and we can see whether some of them can have a loss of surface energies. Previous studies showing that in the patient can have functional cure. Usually, they confirm that we variable clinical outcome. The third one is that we need to identify the new cases from the community. Because some previous surveys showing that, that may be 40 percent of our HBV patients are not aware of their own disease so we need to do some a nationwide screening or community screening to identify those patients and if they are indicated for therapy, but we should give them the drugs. The other one is, we are trying to expand treatment indications according to our risk stratification data. For those are not maybe in the gray zone, but the data showing that they are still had low risks of ACC, I see these patients that can be treated if the cost of the drugs can be reduced further. Finally, of course, we need some novel agents to have functional appeal, HBV, and maybe within a six to 12 months. I think by combining all these majors, we can treat more than 80 percent of our HBV patients. That is the goal of WHO by attendee studies. As you know, there is a slogan of under the pandemic of COVID-19, that is, Taiwan can help and that Taiwan is helping. I think this is the same to HBV treatment, also HBV Control and cure. Accumulating evidence from Taiwan I seen, we are very confident to say that for high-speed, Taiwan can help and that Taiwan is helping. Thank you. Thank you.
