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26 Sep 2019

Scientists converge on Melbourne to accelerate a cure for hepatitis B

Hepatitis B (HBV) is a small virus that can have a big impact. Infecting the liver, it is one of the major causes of liver scarring – or cirrhosis – and liver cancer. 

In Australia, an estimated 240,000 people have the condition – enough to fill the Melbourne Cricket Ground two-and-a-half times. It affects more people than HIV and hepatitis C combined. 

A cure for hepatitis C – a different virus that also causes liver cancer – was introduced in 2016. But a cure for HBV remains elusive. 

However, leading international HBV experts converging on Melbourne from October 1-5 believe a cure for people with hepatitis B is also possible. 

A key focus of the 2019 International HBV Meeting – the first time the event has been held in Australia – will be to find ways to advance a cure, says co-chair, Professor Peter Revill, Royal Melbourne Hospital Senior Medical Scientist at the Peter Doherty Institute for Infection and Immunity, Melbourne. 

In addition to the international conference, a free public forum open to all and a symposium focusing on a cure for HBV will also take place. 

“The International Hepatitis B virology meeting, together with the public forum and the cure symposium, represents the single greatest colloquia of meetings dedicated to the elimination of hepatitis B ever held in Australia,” said Prof Revill, who also leads the International Coalition to Eliminate Hepatitis B (ICE-HBV). “Interestingly, HBV was originally discovered in Australia – by Nobel Laureate, Dr Baruch Blumberg, in 1965.” The co-investigator of this discovery, US Professor Harvey Alter, will be in Melbourne for the meeting. 

HBV attacks the liver and can cause both acute and chronic disease. The virus is transmitted through contact with the blood or other body fluids of an infected person. Most of the transmission worldwide occurs from mother to baby, which can be prevented by vaccination. 

“An effective preventative vaccine against HBV is available and is crucial to the global campaign to eliminate the virus,” Prof Revill said, referring to the vaccine available to newborn babies and young children as part of Australia’s national immunisation schedule. 

“However, it is important we also focus our efforts on a cure to help the more than 250 million people worldwide living with the disease, including those in Australia, for which the vaccine is of no benefit. 

“Current anti-viral therapy, even though it might control the virus, doesn’t eliminate the risk of liver cancer and is lifelong. It drops the risk of progressing to liver cancer by about 50 per cent, but this means there is still a significant likelihood that those affected will go on to develop cancer,” Prof Revill said. 

HBV causes 880,000 deaths worldwide every year – approximately one every 45 seconds. Today, more people die from chronic hepatitis B (CHB) than from malaria. CHB causes almost 40 per cent of hepatocellular carcinoma, the second leading cause of cancer-related mortality worldwide. 

In 2019, chronic hepatitis B is four times more prevalent in Indigenous Australians than non-Indigenous Australians. It’s a key cause of serious illness and death in this community, due to liver disease and cancer. 

Achieving a cure for HBV will be challenging due to the nature of the virus. HBV makes a form of DNA called “cccDNA” which resides in the nucleus of infected liver cells where it is difficult to eliminate. However, Prof Revill said new treatments underway to cure HBV include drugs which directly attack the virus and immune-based therapies which harness the body’s natural immune system – the white blood cells – to fight the infection. These efforts to cure HBV are focused on reducing the viral load and associated viral proteins in the body, restoring individuals’ immune responses. This is called a “functional cure” – similar to when patients naturally rid themselves of the disease and no longer require treatment. 

Meeting the World Health Organisation goals of eliminating hepatitis B virus as a public health problem by 2030 will require a four-pronged approach, Prof Revill said, namely: 

  • Preventative vaccination for babies 
  • Improved diagnosis (only 10% of infected persons are diagnosed at present)  
  • Improved access to treatment 
  • Development of a cure. 

Prof Revill said more investment in research is needed to advance a cure. “Infectious diseases, including those without a cure such as hepatitis B, are drastically underfunded. I would love to see a cure for hepatitis B in the foreseeable future – but this will only occur with a marked increase in funding,” Prof Revill said. 

The 2019 International HBV Meeting is coordinated by the Hepatitis B Foundation

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