2015第二届中国国际丙型肝炎论坛（CHCF 2015）

On behalf of the organizing committee of the 2nd Chinternational hepatitis C Forum (CHCF), we would like to invite you to this hepatitis C forum. The forum will be held in Hong Kong on 7th-8th February 2015.

Worldwide, it is estimated that 40 million Chinese suffered from chronic hepatitis C (HCV) infection. Previously, interferon (IFN) - αbased therapy has led to a drastic reduction in liver-related mortality from chronic HCV infection (end-staged cirrhosis and hepatocellular carcinoma). The standard of care (SOC) therapy has been the use of both pegylated IFN- α and ribavirin (RBV) for either 48 weeks (HCV G1, 4, 5, and 6) or for 24 weeks (HCV G2 and 3), inducing sustained virologic response (SVR) rates of 40%-50% in those with G1 and of 70% or more in those with G2 and 3. However, the treatment uptake has been generally low due to numerous side effects and contraindications to IFNα-based regimens. With the availability of cell culture system allowing subgenomic HCV replicons, new potent, pan-genotypic oral direct-acting antiviral agents (DAAs) have been developed.

The direct-acting antivirals (DAAs) currently in development for treatment of hepatitis C includes NS3/4A protease inhibitors, NS5A protein inhibitors, NS5B (nucleoside-type) polymerase inhibitors and NS5B (non-nucleoside-type) polymerase inhibitors. In US and Europe, SOC has been changed to 12 weeks Sofosbuvir, with PegIFN + RBV or with Simeprevir for G1,4,5,6 and 12 and 24 weeks of sofosbuvir with RBV for G2 and G3. In the near future, one will anticipate the availability of more highly effective, simplified and short duration (8-12 weeks) all oral DAA-based regimens. Notably, by 2015, Sofosbuvir based therapy (with NS5A replication inhibitor such as Ledipasvir or Daclatasvir) or Abbvie Regimen (ABT-450/r-Ombitasvir + Dasabuvir) will become available. 

For Chinese, one of the burning needs is the lack of clinical study with these new DAAs. This will greatly restrict the understanding of efficacy (different HCV genotype), safety and the administration (such as dosing). For instance, in China, the most urgent medical need is to deal with G1b patients who had advance liver fibrosis and are IFN-ineligible (intolerance to IFN, autoimmune hepatitis and other autoimmune disorders, hypersensitive to pegIFN, decompensated liver diseases, major depression, neutropenia, thrombocytopenia) or IFN-experienced. For treatment-naive subjects, as most of them have G1b with IL28B of CC genotype, one will expect IFN-RBV therapy will remain as the SOC.

The cost-effectiveness of these DAAs also needs to be understood, taking into consideration of the wide variation of the economic situation of different countries in Asia. Another important limitation is the lack of access to treatment. Even in well-developed countries in Europe and North America, less than one-fifth of patients with HCV infection have received treatment. Reductions in the burden of HCV-related disease at the population level will require removal of existing barriers to HCV education, screening, evaluation and treatment. Therefore, we need to have practical strategies to enhance HCV evaluation, adherence and treatment response. These measures include integrated care based in the hospital, primary or specialty setting, community-based tele-health, nurse-led education, directly observed therapy and peer-support groups and workers. 

It is the purpose of this hepatitis C forum to provide a platform for all of us to exchange experiences and to be updated on various aspects of chronic hepatitis C infection-diagnosis, pathogenesis and clinical management. Please mark the date and we look forward to seeing you all.