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26 Jul 2018

The time to cure hepatitis B is now

Nature Reviews Commentary lays groundwork for the momentum behind hepatitis B cure research and the long-term implementation of HBV cure preparedness worldwide.

On the eve of World Hepatitis Day, the International Coalition to Eliminate HBV (ICE-HBV), a global group of researchers, patient representatives and health organisations, has called for the integration of a hepatitis B (HBV) cure in global plans to eliminate viral hepatitis.

More than 290 million people worldwide are chronically infected with the HBV, a viral infection that attacks the liver and can cause both acute and chronic disease. Last year, nearly 900 000 people died from the disease.

A safe and effective vaccine to prevent HBV infection has been available since 1982 and its universal delivery is essential for the elimination of HBV as a public health threat. Lifelong treatment is also needed for those already chronically infected but currently is only accessed by some five per cent of the people who need it.

“Some 900 000 people dying unnecessarily of hepatitis B every year is completely unacceptable,” said Associate Professor Peter Revill, ICE-HBV Chair and Senior Medical Scientist in the Victorian Diseases Reference Laboratory at the Peter Doherty Institute for Infection and Immunity (Doherty Institute).

“HBV cure research could make all the difference and prevent adverse outcomes in all people infected with HBV, allowing them to live treatment-free, fully productive lives and reduce the stigma associated with this chronic infection.”

Members of ICE-HBV argue in a commentary published today in Nature Reviews Gastroenterology and Hepatology that there is a need for appropriate cure research and preparedness to complement the World Health Organization´s global elimination strategy, the HBV vaccine and the well- tolerated but poorly accessed therapy.

“It is an ethical imperative that we rapidly scale-up diagnosis and treatment of these ‘missing millions’ and ensure that health systems engage them in order to provide equitable access to cure therapies once they become available,” said Dr Jeffrey Lazarus, an ICE-HBV member and head of the Health Systems Research Group at the Barcelona Institute for Global Health (ISGlobal) in Barcelona, Spain.

The current treatment regime helps keep HBV under control, but it is not a cure and must generally be taken for life. Even with ongoing treatment, people are still at a higher risk of developing liver cancer, particularly those with underlying cirrhosis due to chronic HBV.

It raises issues of medication adherence and requires considerable investment for ongoing monitoring, adding to the challenges of achieving elimination.

Recent scientific progress and the momentum generated by the discovery of a cure for the hepatitis C virus (HCV) has created a sense of hope to find a cure for HBV.

ICE-HBV is calling for increased investments in HBV cure research and cure preparedness to save the lives of the 290 million people living with chronic hepatitis B worldwide, most of whom are unaware of their infection.

ICE-HBV will launch a Global Scientific Strategy to Cure Hepatitis B immediately before the Liver Meeting® 2018 in San Francisco (8 November 2018).  The scientific strategy aims to guide and accelerate research efforts globally, to ensure that the objectives outlined by WHO are sustainably met.

ICE-HBV has already begun moving forward the most urgent research priorities such as developing reliable models and assays to study the impact of new curative treatments under development.

ICE-HBV strongly supports both the World Health Organization global health sector strategy on viral hepatitis and the World Hepatitis Alliance’s ‘Find the Missing Millions’ campaign.

It urges a more universal health coverage approach to the hepatitis B response that has public health and research agencies go beyond the existing objectives and work together to discover and ensure access to curative treatment regimens for people living with HBV.

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