A s a professional society, the American Association for the Study of Liver Diseases (AASLD) is an important instrument for coordinating and focusing the professional objectives of hepatology. As a prelude to an AASLD-sponsored strategic planning initiative, a Future Trends Meeting was convened on January 4-5, 2008. The focus was on the burden of liver disease, the current status of AASLD U.S. physician members, external forces shaping the profession, and manpower/training paradigms. Despite enormous advances in the prevention, diagnosis, and therapy of patients with liver diseases, the burden of liver disease in the United States is substantial. There is an unmet public health need for professional expertise in liver diseases, which is not addressed by current training paradigms. New models of care are needed, funding challenges for sustaining hepatologists need to be addressed, and new training paradigms conceived and implemented. The information reviewed and emerging solutions developed to address the above challenges are reviewed herein. As a new AASLD strategic plan emerges to further refine the concepts developed at this meeting, it will be published in a separate document.
Secular Trends in Liver Diseases
Despite advances in diagnosis, disease-specific interventions, and hospital care, liver-related mortality has remained relatively stable over the last 30 years while overall mortality in patients with liver disease has declined slightly. 1 Much of the overall mortality is due to reduction in deaths due to gallstone disease and gallbladder cancer. 1 Overall liver-related mortality rate exclusive of gallbladder disease has remained relatively stable during this time, though chronic liver disease mortality declined from 1979 to 2004 and has remained steady since that time. 1 The factors involved in these trends are complex and vary by the cause of liver disease.
Hepatitis A virus (HAV) is the most common cause of clinically apparent acute viral hepatitis, accounting for about half of cases. 2 However, the estimated incidence of acute HAV infection and its age-adjusted mortality have fallen dramatically during the last decade. 1,2 HAV vaccine is highly efficacious, and its more widespread use would result in further reductions of the infection. Although acute HAV infection can result in considerable shortterm morbidity, particularly in adults, it does not result in chronic liver disease and therefore its contribution to healthcare resource utilization has declined significantly.
Hepatitis B virus (HBV) is the most common cause of acute hepatitis virus infection and is estimated to account for about a third of clinically apparent cases of acute hepatitis. 3 The incidence has declined over the last two decades, probably as a result of widespread vaccine use in high-risk groups and reduction in high-risk behaviors. A variable proportion of acute cases develop chronic infection, and it is estimated that about 1.25 million persons in