Why you can’t wait to accelerate the fight against hepatitis

Please tell us about yourself and your background as an infectious disease specialist.

Hello, my name is Simon Parker. I am a Senior Market Manager at Roche Diagnostics. My background has been in virology since I started working as a biomedical scientist at the Great Ormond Street Hospital. I moved on to research and researched to get a PhD in developing antibody tests for use in dried blood spot samples.

Academia has been working on several interesting viruses, including hepatitis C. chicken pox (Varicella zoster) – Causes of shingles – Rabies, and the entire group of gastric viruses. After taking off his lab coat, he is working with Roche to commercialize and manage his immunochemistry portfolio.

According to the World Health Organization (WHO), it is estimated that 296 million people worldwide will have hepatitis B and 58 million will have hepatitis C in 2019. increase. Tell us more about the different types of hepatitis infections and their effects. body?

Hepatitis B is a potentially life-threatening liver infection caused by the hepatitis B virus (HBV). It can cause chronic infections and increase the risk of death from cirrhosis and liver cancer. The infection is almost asymptomatic in children, but occasionally in adults, acute illness with symptoms such as yellowing of the skin and eyes (yellowing), dark urine, extreme malaise, nausea, and vomiting is observed. stomach ache..

Hepatitis C (HCV) can cause both acute and chronic hepatitis, ranging in severity from mild to serious life-long illnesses such as cirrhosis and cancer. From flu-like symptoms (muscle pain, fever, etc.) to tiredness, loss of appetite, abdominal pain, mood, and illness, the symptoms are completely unknown. Approximately 30% (15-45%) of infected people resolve the infection within 6 months without treatment. The remaining 70% (55-85%) develop chronic HCV infections. Among people with chronic HCV, the risk of cirrhosis ranges from 15% to 30% within 20 years.

It should be noted that there are other causes of infectious hepatitis for health care and differential diagnosis. The most important are hepatitis A (HAV), hepatitis D (HDV), and hepatitis E (HEV). HAV (Food and Food Preparation) and HEV (Water, Prepared Pork and Blood Donation) are important global issues that spread through the fecal-oral route. HDV is highly related to HBV and needs to be duplicated. Coinfection is considered the most severe form of chronic viral hepatitis because it progresses more rapidly towards liver-related death and hepatocellular carcinoma.

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How are the different types of viral hepatitis spread and how are they currently being treated?

HBV spreads through blood, semen, and vaginal fluid. Methods of spreading it include having sex without a condom, sharing needles, and using non-sterile needles for tattoos. HBV infection is possible by donating infected blood or organs. The HBV test is included in the prenatal screening program because HBV is transmitted from the mother to the baby during pregnancy or childbirth. The younger the first infected person, the higher the risk of developing chronic hepatitis B. HCV is most often spread by blood-to-blood contact by sharing non-sterile needles used to inject recreational drugs and sharing razors and toothbrushes. .. It is possible to transmit the fetus from a pregnant woman, sometimes through unprotected sex. HDV requires HBV to replicate, so it spreads through the same route.

HCV treatment remains a big success story. Direct-acting antivirals have proven to be very effective in treating HCV in over 90% of people. Acute HBV can resolve itself. Chronic HBV treatment is possible in some patients, but diagnosis is crucial. Chronic hepatitis B infections can be treated with medications that contain lifelong oral antivirals. Treatment can slow the progression of cirrhosis, reduce the incidence of liver cancer, and improve long-term survival. In 2021, WHO estimated that 12% to 25% of people infected with chronic hepatitis B would need treatment, depending on their settings and eligibility criteria.

The theme of World Hepatitis Day in 2022 “i can’t wait” (World Hepatitis Alliance) We aim to accelerate the fight against viral hepatitis. Why is it so important to accelerate the global fight against hepatitis?

Scientists understand that the population of undiagnosed chronic HBV and HCV patients at risk for long-term complications such as cirrhosis and cancer continues to grow. This puts a heavy burden on the medical department. Most people with chronic hepatitis B remain asymptomatic (silent) for 20 or 30 years. Similarly, HCV can persist undetected for long periods of time, as symptoms of HCV are often due to other illnesses such as depression, malaise, skin problems, insomnia, pain, and digestive disorders. There is sex. For these reasons, hepatitis C is often referred to as a “silent epidemic.” Therefore, it is important to identify the patient’s infection as soon as possible by screening blood samples or making a correct diagnosis, avoiding serious complications and complications of later treatment. The good news for HCV is that these drugs currently exist that can cure the infection in almost all cases. That is, you can eliminate it.

What is the theme of the campaign “i can’t wait” What do you mean personally?

Appropriate diagnostic tests (with high sensitivity) to correctly distinguish between patients with past infections (thinking about future health burdens) and those with active infections (to be able to treat) It’s all about how you can use the specific ones) to monitor the symptoms, the course of the infection, and hopefully heal). To prevent the spread of infectious hepatitis and treat it appropriately, it is important to know the type of infectious hepatitis. In particular, plans to eliminate HBV and HCV can only be achieved by identifying infected individuals who are unaware that they are infected and have few or no symptoms.

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Please tell me more about hepatitis testing and how to diagnose infectious diseases.

It is very important not only to correctly diagnose hepatitis, but also to identify the correct type of infectious hepatitis for the benefit of patients and society. There are four common routes to differential diagnosis. Biochemical tests are important for identifying abnormal levels of protein in the blood that may suggest abnormal liver function, but the front line of attack is often immunodiagnosis. This is the identification of infectious agents by detecting some of the viruses in the blood.

It may be possible to identify antibodies produced early in the infection that help diagnose acute infections. Given that the virus is involved in the cause of hepatitis, it is important to understand what the virus is doing in the body. Searching for the presence of the virus in the blood is best performed using molecular tests (eg, qualitative or quantitative polymerase chain reaction). [PCR]). These tests will tell you if the patient was simply exposed to the virus in the past or if the virus is actively replicating. Histological diagnosis helps identify prognostic information about cell damage to liver tissue and the extent of the disease.

These tests are often performed on samples sent to a hospital pathology laboratory where highly automated equipment is freely available. Some molecular tests are available at the Point of Care and can be used outside the hospital. This is very important. For example, patients at high risk of HCV infection who are difficult to reach and follow up for treatment or treatment.

Why is viral hepatitis testing a key contributor to the 2022 World Hepatitis Day theme?i can’t wait“?

Viral hepatitis testing is in a great location, with both clinical and point-of-care testing automated, sensitive, specific and cost-effective. In the absence of symptoms, effective diagnostic tests are the best way to diagnose infectious hepatitis and contribute to the WHO eradication goals. The COVID-19 pandemic demonstrates the importance of diagnosis in controlling the spread of infection. Early diagnosis of HCV and HBV in particular can protect hospitals from the consequences of providing long-term, complex care to patients with cirrhosis and cancer.

In addition, antiviral agents are very important in the treatment of HCV and the control of some HBV infections. The challenge is to test the patient, put together a cost-effective program to help identify and treat the patient, and ensure that the patient is aware of the potential for HCV reinfection. Why is someone waiting?

How do you imagine the evolution of hepatitis prevention, testing and treatment over the next decade?

HBV vaccination has been shown to be incredibly successful. In the UK, the hepatitis B vaccine is provided to babies as part of the 6-in-1 vaccine. We look forward to the success of this program in the future. Hepatitis B-specific immunoglobulin (HBIG) is an important post-exposure treatment when infection is suspected and can contribute to prevention. Increasing awareness of sexually transmitted diseases due to drug misuse and poor hygiene has always had a steady impact on decline and requires continued funding. The biggest impact I see is that the healthcare network works with charitable organizations and the pharmaceutical industry to promote HCV diagnosis and identify and treat HCV-infected individuals through targeted screening of high-risk groups. Examples such as removal programs.

What’s next? Do you expect us to quickly reach our global goal of eradicating viral hepatitis in countries around the world?

According to the WHO, 354 million people worldwide are infected with hepatitis B or C and are unaware that almost 90% of viral hepatitis is infected. The ambitious goal of WHO’s global hepatitis strategy was to reduce new hepatitis infections by 90% and deaths by 65% ​​between 2016 and 2030. Eliminate viral hepatitis by 2030.

With this in mind, a new global health sector strategy was approved between 2022 and 2030, including HIV, viral hepatitis and sexually transmitted diseases. This has a common vision of ending the epidemic and promoting universal health, primary health care, and health insurance in a world where everyone has access to high-quality, evidence-based, people-centric health services. Includes 5 strategies aimed at.

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Where can readers find more information?

About Simon Parker

Simon has over 30 years of experience in the field of infectious diseases. He is a Fellow of the Institute of Biomedical Sciences and holds a PhD in Medicine from the University College London, Respiratory, Stomach, Blood infectious virus.

Simon’s background is in virology, where he is involved in pathology, research and development, and manufacturing at NHS, the University, and the National Institute of Biological Standards Control. He currently works as Senior Market Manager at Roche Diagnostics UK Ltd and is deeply involved in developing the Roche Diagnostics portfolio for COVID-19.