As the professor of Department of Medicine, University of Indonesia, Jakarta1, president of APASL2005 (15th, Bali), Dr. Laurentius A. Lesmana has made a significant contribution to the development of hepatology in Asia-Pacific region. In APASL2016, he will share his experience on treatment of HBV in Indonesia and will show us the relationship between the new burdens of the whole world, non-alcoholic fatty liver disease, (NAFLD) with hepatocelluar carcinoma (HCC).
He told APASL Daily that in 2007, the prevalence of hepatitis B in Indonesia is around 9.4%, involved about 230 millions of people. A significant number of patients with chronic hepatitis B (CHB) received the infection via vertical transmission.?HBV infection is also the most common etiology of hepatocellular carcinoma in Indonesia. Most physicians?in Indonesia treat patient with CHB follow the guidelines of APASL, EASL, or AASLD. The majority of patients with CHB preferred to use nucleos(t)ide analogues (NAs) in Indonesia since the cost is significant cheaper ( especially potent NA tenofovir for the reason of generic drugs) compared to pegylated interferon and with much less side effects. In private practice generic tenofovir is the most common used drug. Telbivudine is the only NA covered by the government. Combination of NAs and pegylated IFN is rarely used.
"In our experience most patient patients who received pegylated IFN for 48 weeks relapsed after post treatments."
In other hand, worldwide, liver cancer is the fifth most common cancer and the third leading cause of cancer death. Recently, HCC has been correlated to NAFLD. The exact prevalence of HCC in cirrhotic NAFLD remains unknown. According to Prof. Lesmana, about 6-13% of NAFLD cases may developed to cirrhosis and HCC. For NAFLD patients, diabetes and obesity are major risk factor for developing cirrhosis and HCC. NAFLD can develop directly to HCC probably through different way compared to cryptogenic cirrhosis. Studies of Prof. Lesmana and others accordantly showed that in cirrhotic and non-cirrhotic NAFLD patients, the dimensions of HCC were larger in non-cirrhotic livers.
"The association between NASLD and HCC is alarming due to the globally high prevalence of these conditions and may contribute to the rising incidence of HCC encountered in many developed countries."