In the afternoon of November 19, at the 4th Beijing-Hong Kong Infection Forum, Prof. Wang Guiqiang, Director of the Division of Infectious Diseases and Liver Disease Center, Peking University First Hospital, and Director of the Division of Infectious Diseases, Peking University First Hospital, explained the key points of the 2015 update of China’s guidelines for the prevention and treatment of chronic hepatitis B. After the meeting, our correspondent had the opportunity to interview Prof. Wang Guiqiang. Clove correspondent: In 2015, the World Health Organization (WHO) released its first guidelines for hepatitis B prevention and treatment, and the Asia Pacific Association for the Study of the Liver (APASL) also updated its guidelines for hepatitis B prevention and treatment, what are the main features of the Chinese guidelines compared with these two guidelines? Prof. Guiqiang Wang: The WHO guidelines are applicable to all countries in the world, especially developing countries, so some of them are not applicable to China. For example, HBV DNA testing is not available in some developing countries, but it is not available in our country. First, for the use of strong, low resistance drugs, China’s guidelines are consistent with international ones, recommending the use of two strong, low resistance antivirals, entecavir and tenofovir, as a priority. At present, there are still some problems and peculiarities in terms of drug accessibility in China. In the primary level, there are patients who really cannot afford strong low resistance drugs. For the consideration of patients’ needs, we do not completely exclude other antivirals, but emphasize that if high resistance risk drugs are applied, the treatment should be optimized to improve efficacy and reduce resistance generation. Second, this guideline emphasizes discontinuation indications for interferon therapy. Long-acting interferon is generally recommended for one year of treatment. However, for HBeAg-positive chronic hepatitis B, if HBsAg remains greater than 20,000 IU/ml and HBV DNA decreases less than 2log10 IU/ml after six months of treatment, continued use is not recommended and oral antiviral therapy should be used instead. For HBeAg-negative chronic hepatitis B, if HBsAg does not decrease and HBV DNA decreases less than 2log10 IU/ml from baseline after 12 weeks of medication, it is also recommended to adjust the treatment. Third, about the treatment course. For HBeAg-positive chronic hepatitis B, the basic course of treatment is one year, and if there is serological conversion of HBeAg, HBV DNA is below the lower limit of detection, and ALT is normalized, the consolidation therapy will be at least 3 years, i.e., the total course of treatment is at least 4 years. Although the evidence for this recommendation needs to be further investigated. Overall, long-term treatment with nucleoside analogues is the basic strategy. In HBeAg-negative chronic hepatitis B, the endpoint of treatment is the disappearance of HBsAg. This is consistent with international practice. Fourth, the concern for special populations. The guidelines have clearly recommended the use of antiviral drugs to interrupt mother-to-child transmission in pregnant women with high viral load starting at 28 weeks of gestation, which is basically in line with international guidelines. For mothers with high viral load, the application of immunoglobulin and hepatitis B vaccine to block mother-to-child transmission may still result in HBV infection in some newborns. Therefore, for pregnant women with HBV DNA greater than 2×106IU/ml during the immune tolerance period, the application of tenofovir or telbivudine antiviral is recommended to block mother-to-child transmission with informed consent. In addition, the Chinese guidelines specify for the first time the application of antiviral treatment for hepatitis B virus-associated glomerulonephritis, and some patients can control urinary protein with antiviral treatment. In addition, the indications for liver failure due to hepatitis B were relaxed, and antiviral therapy is recommended for both HBsAg positive or HBV DNA positive. Clove correspondent: It has been 5 years since the last edition of the guidelines. What are the major achievements in the prevention and treatment of hepatitis B in China in the past 5 years? Prof. Guiqiang Wang: In terms of prevention, the use of hepatitis B vaccine has greatly reduced the rate of HBsAg carriage in China. In 2014, the results of a national seroepidemiological survey on hepatitis B in people aged 1 to 29 years conducted by the Chinese Center for Disease Control and Prevention showed that the detection rates of HBsAg in people aged 1 to 4 years, 5 to 14 years and 15 to 29 years were 0.32%, 0.94% and 4.38%, respectively. The overall HBsAg carriage rate in the population has decreased significantly, which is a major achievement in public health in China. In the clinical aspect, the accessibility of drugs has been improved, and all internationally available anti-hepatitis B drugs are available in China, but there are still some problems with prices. For example, the WHO and European guidelines recommend tenofovir and entecavir in order of potency and low resistance, but the price of tenofovir in China is different from that of Europe and the United States, and is higher than that of entecavir, so our guidelines recommend entecavir and tenofovir in order. In addition, in the indication for antiviral therapy, the age of treatment has been advanced from 40 years in the previous version to 30 years, advocating aggressive antiviral therapy. In terms of scientific research, there is increasing evidence that antiviral therapy is effective in reducing the incidence of cirrhosis and hepatocellular carcinoma, and the evidence in this regard is now clear, deepening our understanding of the antiviral concept. The indications for discontinuation of interferon and the course of medication are all new understandings and changes over the years. Some achievements have also been made in clinical testing and diagnosis. For example, in the non-invasive diagnosis of cirrhosis, the guidelines recommend liver transient elastography system for the diagnosis of cirrhosis. Clove Correspondent: What are the biggest problems and challenges facing the prevention and treatment of hepatitis B now? What is the main direction of work? Prof. Guiqiang Wang: The biggest challenge is that there is still no breakthrough in drugs for the eradication of hepatitis B. At present, hepatitis C can be cured by antiviral small molecules, but the current hepatitis B virus treatment can only control the progression of the disease, and most of them cannot be completely cured. This guideline also proposes the pursuit of clinical cure for some patients, i.e., clinical cure through treatment to achieve HBsAg clearance. Since no new anti-hepatitis B drugs will be available in the near future, the current focus and research direction is still to study the use of existing drugs to maximize their efficacy. For example, the guidelines mention that sequential or combined long-acting interferon therapy with nucleoside analogues can improve the clearance of HBeAg or HBsAg. Although our scholars have made some research results in this area, the timing and mode of sequential or combination therapy still need further study. Hopefully, these studies will lead to clinical cure in more patients. In addition, the non-invasive diagnosis of cirrhosis is also a hot research area. Currently, there are major research projects supported by the National 12th Five-Year Plan, and we hope to develop our own non-invasive diagnosis system in the future.