South African GASTROENTEROLOGY Review | Volume 17 Issue 3 2019

THE SOUTH AFRICAN GASTROENTEROLOGY REVIEW 2019 | ISSUE 3 | 36 GASTROENTEROLOGY FOUNDATION liver injury attributable to prescription and non- prescription medications, including herbals and dietary supplements. In addition to staff and students, this eponymous lecture was attended by a number of notable guests including Professor Solly Marks’ daughter, Mrs Karen Tollman, previous Heads of Departments of Medicine and Surgery, donors of the Gastroenterology Department, and members of the SAGES Council. By all accounts it was very well received. Dr Hoofnagle also gave the Professor Michael Kew Eponymous Lecture entitled “Hepatitis B, 50 years on” at SAGES. Despite effective vaccination and antiviral therapy, Hepatitis B remains endemic in South Africa with a prevalence of 6.7%. The lecture covered the Hepatitis B lifecycle, phases of chronic infection, pathophysiology and treatment. He discussed indications for treatment, duration of treatment and the potential to stop antivirals using new virologic markers of HBV replication such as serum HBV RNA and HB core Ag as predictors of HBsAg loss. Serum HBV RNA and HB core Ag are present in moderate titres in patients with high titres of HBV DNA and may persist despite marked HBV DNA suppression during nucleoside therapy. Their presence demonstrates the persistence of HBV cccDNA and production of the HBV pre-genome and predicts loss of HBsAg if the titres decrease and therefore the potential to consider stopping therapy. At present, a number of curative therapies targeting the immune system, viral replication and cccDNA are being investigated; these include Myrcludex B (a HBV entry inhibitor, targeting the sodium taurocholate receptor), HBV capsid assembly modulators, inhibitors of protein translation by siRNA, silencing of cccDNA, HBV core Ag inhibitors, polymerase inhibitors, HBsAg release inhibitors and immunomodulators. Future therapeutic directions will probably require combination therapy for the promise of a cure for HBV infection. We are grateful to the Department of Medicine and The Gastroenterology Foundation of South Africa for supporting Dr Jay Hoofnagle’s visit as the 2019 Solly Marks Visiting Professor. Wendy Spearman and Mashiko Setshedi From left to right: Geoff Dusheiko, Jay Hoofnagle, Jean Botha, Mike Kew, Lewis Roberts, Chris Kassianides, Ray Kim and Martin Veller From left to right: Jay Hoofnagle, Mike Kew, Chris Kassianides