World Hepatitis Day
4000 deaths a day around the world, is 4000 too many.
Liver disease is the only major cause of death still increasing year-on-year. It is the fifth biggest killer in England and Wales and kills more people than diabetes and road deaths combined. At least 250,000 people in the UK and 130-200 million people worldwide are thought to be infected with hepatitis C virus (HCV) a blood-borne virus which can cause severe liver damage in up to 20 per cent of patients. HCV is a smouldering international public health crisis – it is ten times easier to contract than HIV and much about HCV remains to be fully understood.
To mark World Hepatitis Day, MRF-funded Dr John McLauchlan of the MRC-University of Glasgow Centre for Virus Research provides an update on the important contribution that the MRF is making to tackle HCV infections:
“In 2010 the MRF provided over £2m to establish a biorepository and clinical database of samples and data from patients with HCV infection (HCV Research UK). Since then new antiviral drugs, called direct-acting antivirals (DAAs), to treat and cure patients of their infection have been developed. The emerging options for treatment are transformative and clinical trials have shown that it is now possible to clear the virus in a high percentage of those who are infected. The new DAAs can be taken as pills so the need for injections of interferon, which can have nasty side-effects, is no longer necessary for many patients and the length of treatment is shorter. These new therapies are now becoming available in the clinic. So what contributions will HCV Research UK make as we enter this new era?
Firstly, HCV Research UK had a target of recruiting 10,000 patients with the aim of promoting research into fundamental clinical and scientific questions on the virus by making clinical data and samples available to scientists, clinicians and pharmaceutical companies. We have exceeded that figure by more than 500 patients and the network has grown to about 60 clinical centres treating HCV patients across the UK. The resource is now providing data and samples for more than 30 academic studies on HCV infection and this will continue into the future.
At the point where the 10,000 patient target was in sight and we were making plans to wind down recruitment, NHS England announced that it would make the new antiviral drugs available, before their approval by the National Institute for Health and Care Excellence (NICE), to seriously ill patients in desperate need of treatment. This became known as the Early Access Programme. Given the scale of the HCV Research UK network and the infrastructure that had been created with MRF funding, we agreed to collect data on the outcome of the Early Access Programme for the NHS. More than 700 seriously-ill patients received the new drugs and we collected samples and data from this unique cohort. The results have been received with excitement at one of the major international liver meetings. Our findings show that, even though these patients have very serious liver disease, almost 80% have successfully responded to the new DAAs and are now cured of infection. Half of the patients who have responded also show improved liver function.
Crucially, it is now important to work out why a significant proportion of these patients did not respond to the new therapy. There are a number of UK groups working with us to answer this question and come up with the most effective treatment for those infected with HCV. In most of the patients who have not responded, the virus emerges again after the end of treatment. There are many likely causes including either the development of resistance by the virus to the drugs or slight variations in the genetic makeup of these patients. The data and samples that we have collected with MRF funding will be vital for scientists and clinicians to answer these questions.
There is also a tragic side to the introduction of the new therapies. Many patients sadly died while on therapy because of the extent of their liver deterioration due to the infection. This underlines the human cost of chronic HCV infection and the need to provide treatment to patients before the onset of serious disease. In a forward-thinking initiative, HCV Research UK has partnered with other clinicians and scientists to put together a cohort of patients with cirrhosis, an early sign that may signal irreparable damage to the liver. These patients will be followed over the next 5 years to discover any biomarkers that predict serious disease, including liver cancer. Those who successfully clear the virus with treatment will also be monitored to investigate the long-term effects of successful cure.
We still have some way to go to defeat HCV but we now have more firepower in our arsenal. As the campaign to mark World Hepatitis Day states, 4000 deaths a day around the world, is 4000 too many.”
The MRF’s Director, Dr Angela Hind, says “HCV Research UK has been a phenomenal success story for the MRF and for the donors who made this possible – the late Miss Effie Millar Munro and Mr Alfred Tartellin who both left legacies to the MRC to support research into liver diseases. But more importantly, it has been a huge step forward for the health of the individuals in the UK and around the world who are infected with HCV and who will benefit from the research results that are being generated by HCV Research UK. This has been an amazing collaboration between charity supporters of the MRF, HCV scientists and clinicians and the patients who generously donated biological samples and clinical data that have, and will continue to have, a lasting impact on human health”.
There is much still to be done to defeat HCV research and other liver diseases. If you would like to support UK scientists to tackle this, you can make a donation to the MRF for research on liver diseases.