Prof Yi-Hsiang Huang shares the Taiwan Liver Story – Expert Insights from LEAD 2025, the leading APAC Liver Disease Expert Meeting

This is a verbatim transcript of an interview conducted with Prof Yi-Hsiang Huang in June 2025. The transcript has been lightly edited for clarity.

Introduction

I’m Yi-Hsiang Huang, the president of Taiwan Liver Cancer Association and now the hepatologist in Taipei of Attorney General Hospital.

How would you describe the current chronic liver disease landscape in Taiwan?

I think that in Taiwan, the prevalence of hepatitis B was high in the past, before the era of HBV vaccination. So right now, for patients aged older than 40, the prevalence of hep B is around 10%. For hep C, it’s generally around 3–5% in Taiwan.

Right now, [with] the HBV vaccination in young adult, the prevalence is around <1% for hep B, and for the new generation, for hep C, I think the prevalence is quite low, especially after the DAA (direct-acting antiviral) treatment.

What are the current obstacles to hepatitis elimination and hepatocellular carcinoma (HCC) surveillance in Taiwan? How can clinicians counter them?

So for HCC, currently it is still the main cause of death in Taiwan. It ranks [as] the second [highest] cause of death according to recent data. So, HCC is around 7,000 to 8,000 new cases each year in the past 5 years. So the cause of HCC in Taiwan, majority is coming from chronic hepatitis B. It accounts for around 40–50% of the new patients, and for hep C is around 20–30%, and for the rest of them not belonging to viral hepatitis, I believe most of them are really related to the so-called fatty liver disease, or right now the MASLD.

The age distribution of the patients is something different for hep B and hep C. In our previous study, the median age for hep C is around 10 years older than hep B patients. But for non-B, non-C patients, the median age is even older than viral hepatitis–related HCC.

More than half of the patients are diagnosed at the intermediate to advanced stage HCC. That means that those patients cannot be treated by a curative method. I think the HCC is still coming from chronic hepatitis and also from viral hepatitis, but viral hepatitis elimination is the goal of WHO by 2030.

In Taiwan, we set a goal in 2025, but we still have a small step to achieve the goal. First, I think that patient awareness is the key limitation, because currently most HCC patients still come to our clinic in an intermediate to advanced stage. They come to us because they have abdominal pain, fullness, and symptomatic illness. At that time, those patients may not be expected to have long-term survival. So I think it is a key issue that we should conquer.

But I think the most important one is due to [the fact that] we have some people living in rural areas, so the medical care may be some limitation for those patients. So I think that’s the key issue that we should consider: how to find those patients and how to make patients more aware of their liver disease.

What strategies has Taiwan adopted to progress towards hepatitis elimination?

I think that hepatitis elimination is our country’s goal. So we set the goal 5 years ago and then we tried to treat hep B, hep C patients. So right now, the reimbursement criteria have in fact expanded to chronic hep B patients and also for hep C patients.

For hep C patients, if you detect that they have HCV viral load, then we can treat those patients, no limitation. But the key issue is still the awareness. For hep B, right now we still have some limitations to treat all patients because according to the recent guideline by WHO, they expanded the treatment goal. But in Taiwan, we still set a limitation, [that] patients should have at least a twofold upper limit of normal ALT and may have at least HBV viral load higher than 2,000 IU/mL for chronic hep B patients.

But I think we have to spend more to treat more hep B patients. In that way we can control more hep B patients, and we can decrease more patients at risk of HCC.

And another issue is for the non-B, non-C HCC. Currently, we believe most of them are coming from fatty liver, the so-called MASLD. For MASLD HCC, most patients come to us without obvious liver fibrosis. Those tumours are hard to detect by ultrasound, so we have to develop more sensitive markers, to detect a patient at risk of liver fibrosis and also at risk of HCC for non-B, non-C HCC cases.

Recently our government also urged us, our society, to set up a guideline to treat those patients with fatty liver. So in that way I think most hepatologists and all the multidisciplinary doctors can join together to do that.

Well, HCC surveillance we rely on a more sensitive biomarker, but we know that alpha-fetoprotein alone is not enough. So our government has reimbursed PIVKA-II as a biomarker for patients with underlying liver cirrhosis or already diagnosed as HCC. However, I believe it’s not enough because so far, the reimbursement criteria only allow twice a year for PIVKA-II. But as we know, for patients with high risk of HCC, that means severe liver fibrosis or already HCC cases, they should be screened every 3 months. So the interval and the duration of the PIVKA-II survey should be at least four times a year. Our society is trying to negotiate with our National Health Insurance Bureau to expand the reimbursement criteria.

How is Taiwan strengthening its HCC surveillance efforts to improve early detection and outcomes? What key learnings or best practices would you share with other Asia-Pacific countries aiming to advance chronic liver disease management?

I think Taiwan was the first country to introduce the nationwide neonatal HBV vaccination. And currently we also are using the government policy to treat chronic hep C patients. And ongoing, we are doing non-B, non-C liver disease screening. So by this way, I think it’s a good model to tell the APAC countries, and we can work together to control liver disease and eventually decrease the incidence of HCC in the future.

I think to treat liver disease and also the HCC, we need multidisciplinary doctors to work together. For example, for patients who come to us with a liver lesion or liver tumour, we need a radiologist to give us a precise imaging diagnosis. And for patients with maybe high risk of HCC and the existing liver lesion, for example, they have a high GALAD score or high PIVKA-II level and also a liver lesion, then we should do the liver biopsy, and then we require the pathologist to give us a very precise pathological diagnosis. And after that, we should work together to think about how to treat this tumour. And we need a liver surgeon, and the liver, we need an interventional radiologist. And also, we need some medical oncologists together with our hepatologists to make a decision on how to make the best for our patient.

But I think today there’s still some hospitals that have some limitations. A good referral system to transfer those patients who require more comprehensive surveys and more comprehensive treatment is required.

The views and opinions expressed by Prof Yi-Hsiang Huang are his own views and opinions. Roche disclaims all liability in relation to these views and opinions.