Research gaps in viral hepatitis

Abstract

IntroductionThe World Health Organization has aimed for global elimination of both hepatitis B virus (HBV) and hepatitis C virus (HCV) by 2030. Treatments available to cure HCV and control HBV, as well as vaccination to prevent HBV infection, have certainly allowed for such bold goals, yet the final steps to usher in elimination require further evidence.DiscussionWe broadly discuss the needs for three major public health approaches. First, an effective vaccine exists for HBV and mass‐vaccination campaigns have resulted in decreases in hepatitis B surface antigen seroprevalence and overall rates of liver‐related morality. Still, HBV vaccination coverage is poor in certain regions of the world, while the reasons for such low coverage require further study. A prophylactic vaccine is probably needed to eliminate HCV, but is not being readily developed. Second, identifying HBV/HCV infected individuals remains a priority to increase awareness of disease status, particularly for key populations. Research evaluating large‐scale implementation of novel, rapid and mobile point‐of‐care tests would be helpful to determine whether increased awareness is achievable in these settings. Third, antiviral therapy allows for strong HBV suppression and HCV cure, while its access depends on financial factors among many others. Although there is strong evidence to treat key populations and specific groups with progressed disease, as stated in current guidelines, the advantages of extending treatment eligibility to decrease onward spread of HBV/HCV infection and prevent further burden of disease are lacking “real world” evidence. Novel anti‐HBV treatments are being developed to target intrahepatocellular HBV replication, but are still in the early phases of clinical development. Each of the strategies mentioned above has specific implications for HIV infection.ConclusionsThere are certainly effective tools to combat the spread of viral hepatitis and treat infected individuals – yet how they are able to reach key populations, and the infrastructure required to do so, continue to represent the largest research gap when evaluating the progress towards elimination. Continuously adapted and informed research is required to establish the priorities in achieving elimination goals.

Higher rates of HBsAg clearance with tenofovir-containing therapy in HBV/HIV co-infection

“…Moreover, we identified other predictors of HBsAg loss, such as a prompt initiation of HBV therapy, and HBV treatment duration, in accordance with previous reports [31–32]. However, the delay between diagnosis and treatment initiation included in the model might not reflect the total duration since HBV infection, as HBV is largely undiagnosed in some key populations [33]. CD4+ T cell count has also been previously identified to negatively correlate with HBsAg clearance [34].…”

Long‐term clinical benefits of Sofosbuvir‐based direct antiviral regimens for patients with chronic hepatitis C in Central and West Africa

“…36 Innovative means to both TA B L E 2 Mortality and morbidity in fictive cohorts of CHC patients with and without DAAs treatment (n = 3224 in Cameroon, n = 9748 in Côte d'Ivoire and n = 6358 in Senegal) diagnose CHC cheaply and quickly using a single test are needed. 37 Existing alternatives include dried blood spot tests, point-of-care and HCV core antigen measurements. The latter is an indirect marker of viral replication with good performance already demonstrated in the SSA setting.…”

A Voting Ensemble Approach for Hepatitis Disease Detection

“…Presence of hepatitis virus in liver can damage can hamper patients' lives. According to (1), around 1.34 million deaths occurred due to this disease in 2015. The World Health Organization (WHO) has fixed target of eliminating hepatitis B, hepatitis C virus within 2030.…”