A National Strategy for the Elimination of Hepatitis B and C Phase Two Report (2017) / Chapter Skim
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7 Research
7 Research
Pages 177-202
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From page 177... ...
infection affects 3 to 5 times more Americans than HIV, for example;1 worldwide, it is about 10 times more.2 But NIH funding for viral hepatitis between 2012 and 2017 has been between $195 and $273 million a year, 1 The Centers for Disease Control and Prevention (CDC) estimates 1.2 million cases of HIV in the United States, 2.7 to 3.9 million chronic hepatitis C, and 850,000 to 2.2 million chronic hepatitis B (CDC, 2016a,b)
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. In the early 1980s, most HIV research was within the purview of the National Institute of Allergy and Infectious Diseases and the National Cancer Institute, but as the virus emerged as an international epidemic, NIH leaders realized that no one institute's mission was sufficient to encompass the necessary research agenda (NIH, n.d.)
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. A recent study in New York City found that only 20 percent of people tested for HCV antibody have a confirmatory HCV RNA test, and among those who received a confirmatory HCV RNA test, the median wait time for testing was 13 days (IQR, 2 to 52 days)
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Mechanistic Research There can be no elimination of HBV and HCV infections without enhanced understanding of the fundamental biology of these viruses and novel therapeutic targets (Palese, 2016)
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. Molecular Epidemiology and Phylodynamic Methods As elimination efforts proceed and viral hepatitis prevalence decreases, case finding will become more difficult and the study of ongoing transmission networks more important.
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Rapid Diagnostic Testing for HBV DNA and HCV RNA Rapid or point-of-care tests can help avoid attrition on the viral hepatitis care continuum from the start. With rapid tests, people receive counseling and test results all in one interaction, limiting opportunity for loss to follow-up.
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From page 183... ...
Of particular interest would be research to simplify the hepatitis B vaccine schedule and reduce vaccine failure, and ways to shorten or enhance success of antiviral therapy, and further reduce mother-to-child transmission of HBV. Hepatitis B in Pregnancy Recent evidence suggests that it is possible to prevent chronic hepatitis B in newborns born to highly viremic, HBeAg+ women with prophylactic antiviral therapy in addition to standard newborn prophylaxis with hepatitis B immune globulin and vaccine (Pan et al., 2016)
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. As with antibody response, broadly directed T cell responses appear early in natural infection, but are rapidly lost in chronic infection (Schulze Zur Wiesch et al., 2012)
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. It will be difficult to eliminate chronic hepatitis B in the face of potential reactivation of HBV infection.
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. Guidelines for detection of hepatocellular carcinoma in persons at risk, including those with HBV or HCV infection, are well-established despite limited data, but adherence to the guidelines is poor, even among specialists (Bruix and Sherman, 2011; Hearn et al., 2015; Sharma et al., 2011; Wu et al., 2014)
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From page 187... ...
Longitudinal study of these correlates should help identify people at minimal risk of liver cancer for whom frequent screening may not be necessary. Hepatocellular carcinoma remains a risk among hepatitis B patients whose HBV DNA is suppressed and in hepatitis C patients with cirrhosis who have not been cured (de Oliveria Andrade et al., 2009; El-Serag, 2012; Fernandez-Rodriguez and Gutierrez-Garcia, 2014)
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. Fewer than 0.1 percent of inmates in the United States receive opioid agonist therapy, the modern treatment standard for opioid addiction (Larney et al., 2011; WHO, 2009)
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Prisoners would benefit from having research done on their behalf, as would society benefit from better understanding the safest and most efficient strategies to return inmates to their communities in the best health possible. The transition from prison to civilian life, particularly the health risks of this transition, would also benefit from research attention.
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. The complex adaptive systems strategy has been successful in studying health programs, especially at determining why some strategies work and others do not, as well as modeling the likely outcomes of different strategies (Jordon et al., 2010; Paina and Peters, 2012)
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Another feature of the epidemic of injection drug use described in Chapter 5 that warrants particular research attention is injection drug use in people younger than 30. Young adults and adolescents who inject drugs are thought to be fueling spikes in HCV infection in the United States, but less is known about how to reach this group with harm reduction and other health services (Page et al., 2013; Stockings et al., 2016)
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. A more recent tool, the Behavioral Risk Assessment for Infectious Diseases, looks specifically at drug use other than injection (Dunn et al., 2016)
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2012. Innate and adaptive immune responses in chronic hepa titis B virus infections: Towards restoration of immune control of viral infection.
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2014. Prevention of hepatocellular carcinoma in patients with chronic hepatitis B
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2011. A systematic review and meta-analysis of interventions to prevent hepatitis C virus infection in people who inject drugs.
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2016. Antiviral therapy for chronic hepatitis B viral infection in adults: A systematic review and meta-analysis.
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2013. Eradica tion of hepatitis C virus infection and the development of hepatocellular carcinoma: A meta-analysis of observational studies.
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2013. Durability of a sustained virological response, late clinical sequelae, and long-term changes in aspartate aminotransferase to the platelet ratio index after successful treat ment with peginterferon/ribavirin for chronic hepatitis C: A prospective study.
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immunoglobulin G antibody avidity as a biomarker to estimate the population-level incidence of HCV infection. Journal of Infectious Diseases 214(3)
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2011. Systematic review and meta-analysis of survival and disease recurrence after radiofrequency ablation for hepatocellular carcinoma.
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2014. The treatment cascade for chronic hepatitis C virus infection in the United States: A systematic review and meta analysis.
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