Taiwan leads global fight against hepatitis
Jul 12, 2013

Taiwan’s achievements in hepatitis B prevention and treatment have long stood as a shining example for the rest of the world, underscoring the commitment and dedication of a group of outstanding local doctors and researchers.

Liaw Yun-fan, a distinguished chair professor and director of the Liver Research Unit at the Chang Gung University Medical College, is one of these global trailblazers in liver study.

On April 26, Liaw received the prestigious International Recognition Award from the European Association for the Study of the Liver in recognition of his 36-year contribution to viral hepatitis clinical research and developing practical treating strategies.

“This award is not a personal tribute but one representative of the entire team’s exceptional work,” Liaw said during a June 14 interview with Taiwan Today.

“I also dedicate this honor to my mentor Sung Juei-low, who passed away May 26 at the age of 96. He paved the way for my work in the field of liver disease research.”

Liaw, 72, published 459 papers with 18,958 citations worldwide pertaining to liver disease research. His main contribution was the characterization of the natural history of the infection in the 1980s, including the definition of clinic-pathological events associated with the chronic active hepatitis, the events preceding hemoglobin E seroconversion, and the clinical features of hepatitis B virus reactivation, according to Geneva-headquartered EASL.

“There are no fancy machines in my laboratory,” Liaw said. “What we do is study serum samples and biochemical test results from a very large number of patients.

“Our study has received international recognition because they are practical and effective in solving patients’ problems.”

Liaw said when he started practicing medicine, hepatitis B was a new area with physicians knowing nearly nothing about its origin of infection, clinical development and symptoms.

In those days, Taiwan had the highest chronic HBV rate in the world, with 20 percent of the local population carriers compared to 1 percent in the U.S., according to Liaw.

“Sung and his team pioneered studies of the disease and later indentified mother-to-infant transmission as one of the main reasons for such prevalence.”

Taiwan has since made headway in fighting HBV and related diseases, Liaw said, adding that a milestone was the 1984 implementation of the world’s first large-scale hepatitis B vaccination program, which helped slash the carrier rate in children from over 10 percent to less than 1 percent.

“I chose to focus my study on HBV and related diseases because I wanted to be able to tell my patients what they have and how I can help improve their lives,” Liaw said.

“The most frightening thing for patients is the unknown, and it is the doctor’s responsibility to answer questions and ease concerns.”

In 1985, Liaw published a landmark paper in collaboration with a team led by Howard Thomas, emeritus professor of medicine at London’s Imperial College. The study detailed the characterization of different phases of hepatitis B: the immune tolerant phase, immunoactive phase, and the residual phase, or inactive carrier state.

These phases reflect the immunopathological mechanism of chronic HBV infection and are now classically recognized by all physicians managing hepatitis B patients.

Liaw’s extensive clinical studies of new antivirals and predictors of treatment outcome formed the basis of his first-of-a-kind hepatitis B treatment recommendations and guidelines published in 2000. Adopted by international liver societies and physicians, the guidelines were updated 2003, 2005, 2008 and 2012 under Liaw’s supervision.

Vaccination and treatment of HBV are key to reducing the spread of the virus and preventing patients with chronic hepatitis from progressing to liver cirrhosis or cancer, according to Liaw. “Hepatitis medicines such as interferon might be invented by others, but Taiwan physicians make the best use of it.”

In 2003, antiviral treatment of hepatitis B and C entered a new era in Taiwan with the National Health Insurance program initiating coverage for the use of related medicine.

“Taiwan is a global pioneer in the fight against hepatitis B,” Liaw said. “Our experience in HBV prevention and treatment can serve as great examples for other countries.”

With the World Health Organization’s Global Hepatitis Network established June 7 in Singapore, Liaw said Taiwan can look forward to playing a greater role in the field.

But there is more to be done in Taiwan, Liaw said, including lifting restrictions on NHI subsidies for a maximum of two three-year treatments per patient, and launching a national compulsory HBV screening program.

On clinical research, Liaw said he hopes to see more young doctors dedicated to HBV studies and development of new medicine. “My biggest medical achievement is that the findings of my studies are being used to improve patients’ lives.

“Sung taught me that good doctors should never stop caring for their patients and studying the unknown. I am proud to say that I have put that into practice with patients and families my biggest motivation.” (JSM)

Write to Rachel Chan at ccchan@mofa.gov.tw