Research gaps in viral hepatitis.

Anders Boyd,Karine Lacombe,Léa Duchesne

doi:10.1002/jia2.25054

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.

Highlights

The World Health Organization has aimed for global elimination of both hepatitis B virus (HBV) and hepatitis C virus (HCV) by 2030
A targeted testing approach is not explicitly recommended for HBV [19], with the broad exception of testing all those “who do not know their status” [6], but is recommended for HCV based on risk or birth cohort [20]
In the short-term, HBV vaccine coverage should be increased to all regions of the world, while the reasons for reluctance to vaccinate could provide insights on accomplishing this goal

Summary

| INTRODUCTION

The 2015 update of the Global Burden of Diseases study has ranked chronic viral hepatitis and its underlying conditions, such as cirrhosis and liver cancer, among the top 20 causes of death, steeply increasing from 1990 to 2015 [1]. Novel direct-acting antivirals (DAAs) have allowed for short-term and effective treatment against HCV and are known to induce high rates of sustained virological response (SVR) [3] With these effective means at hand, the World Health Organization (WHO) has aimed to achieve global elimination of both infections by 2030. Elimination implies strengthening existing tools – more efficient screening policies, wider access to care and management of liver disease, and antiviral agents that halt the virus. In this commentary, we broadly highlight some recent advances, and room for improvement, in three public health strategies geared towards HBV and HCV elimination that include HIV coinfected individuals: vaccination, testing and treatment

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Findings

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