Taiwan is an endemic area of hepatitis B virus (HBV) infection. More than 90% of the general population has been infected with HBV, and the prevalence of chronic infection is as high as 15% to 20%. Liver cancer is the first leading neoplasm for men and the third for women. Its age-adjusted incidence per 100,000 was 48 for men and 18 for women in 2000. Malignant neoplasm was the leading cause of death, and liver cancer was the leading cause of cancer death in Taiwan in 2000. Deaths from cirrhosis and chronic liver diseases also ranked as the sixth leading cause of death.
Several early clinical trials on the efficacy of hepatitis B immunoglobulin and HBV vaccine in children were carried out in our country. A nationwide HBV vaccination program for newborns was implemented in 1984. A significant decline in seroprevalence of hepatitis B surface antigen and in childhood hepatocellular carcinoma (HCC) has been observed among vaccinated children. However, 2 million adult patients are still affected with chronic HBV infection. The seroprevalence of hepatitis C virus (HCV) infection has been reported as 2% to 3% in the general population, with the highest prevalence of >20% in several hyperendemic villages, where iatrogenic infection is the major transmission route. The National Health Insurance reimburses the treatment of chronic infection of HBV and HCV in Taiwan.
Hepatology is a research field with a top priority in Taiwan. Major medical research in Taiwan is carried out in 11 medical colleges, six medical centers not affiliated with universities, and three major research institutions: Academia Sinica, National Health Research Institutes, and Industrial Technology Research Institute. Medical research is mainly supported by governmental funding agencies, including the National Science Council, the Department of Health, and the Ministry of Economical Affairs. The budget in U.S. dollars for hepatological research in 2003 was 4.1 million from the National Science Council, 2.2 million from the Department of Health, and 3.9 million from the Ministry of Economical Affairs, with a total of 137 research projects funded.
There are two major multidisciplinary program projects on hepatology. One is the genomic study on HCC by the National Science and Technology Program Project, cosponsored by the National Science Council and the Department of Health. Another is the development program of Chinese herbal medicine for liver diseases sponsored by the Ministry of Economical Affairs. Other currently funded studies include those on changes in secular trend and geographical variation of HBV- and HCV-related HCC; natural history and pathogenesis of chronic hepatitis; molecular and chromosomal changes in liver cirrhosis and HCC; functional genomics and proteomics of viral hepatitis and HCC; pharmacogenetic studies on chronic hepatitis B and C; interaction of viral and host genotypes in the development of chronic hepatitis and HCC; efficacy and cost-effectiveness of methods for early detection of small HCC; efficacy of antiviral drugs in treatment of chronic HBV and HCV infection; randomized clinical trials on various treatment modalities of HCC; randomized trials on HCC screening in high-risk populations; identification and purification of active components of herbal medicine for treatment of chronic viral hepatitis and HCC; animal studies on gene therapy of HCC; HBV DNA vaccine and liver transplantation.
There are five major hepatology research teams in Taiwan. The Hepatitis Research Center at National Taiwan University Hospital was established by Prof. Juei-Low Sung and Ding-Shinn Chen in early 1980s. In recent years, its research has concentrated on virus- and host-specific genetic polymorphisms that may determine disease and treatment outcomes. The Hepatitis Research Unit at Taipei Veteran General Hospital was founded by Prof. Kwang-Juei Lo and Shou-Dong Lee. Its major research activities focus on transmission of hepatitis viruses and clinical trials of the efficacy of vaccines against hepatitis A virus and HBV. The Liver Research Unit at Taipei Chang-Gung Memorial Hospital founded by Prof. Yun-Fan Liaw emphasizes research on clinical pathology and pathogenic mechanisms of acute exacerbation of viral hepatitis, as well as its treatment and prognosis. The Liver Transplant Center at Kaohsiung Chang-Gung Memorial Hospital founded by Prof. Chao-Long Chen focuses on clinical and experimental aspects of transplantation, including work on a bioartificial liver. The HCC Epidemiological Research Unit at College of Public Health, National Taiwan University, established in the late 1980s, examines molecular and clinical aspects of HCC in our country.
The future perspective of hepatological research in Taiwan is exciting. There will be more multidisciplinary and international collaboration in both basic and clinical investigations. Through the steady increase in financial support from governmental funding agencies and well-experienced researchers, it is expected that more effective and efficient methods for prevention and treatment of liver diseases will be developed. Along with the comprehensive reimbursement for health care from National Health Insurance, the burden of liver diseases in Taiwan will be reduced in coming decades.