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Viral hepatitis is an infectious disease transmitted through blood or body fluids, causing liver inflammation. Hepatitis B and C are the most common forms of chronic (long-term) viral hepatitis and, if left untreated, can lead to liver disease and liver cancer. Viral hepatitis is the leading cause of liver cancer worldwide.

Interferons are naturally occurring proteins that trigger the body’s immune system to fight disease. Injections that boost the production of interferons within the body were used to treat both hepatitis B and C until the last decade. However, these injections targeted the wider immune system rather than the virus itself, so they varied in effectiveness and caused unpleasant side effects.

Since the early 2000s, researchers have advanced the science behind treatments to develop the highly effective antiviral drugs available for both hepatitis B and C today. These therapeutics target the virus directly, reducing side effects and improving effectiveness compared with previous interferon treatments. In the case of hepatitis C, this innovation has led to highly effective cures for 95% of people treated.

Affordable cures saving lives and curbing hepatitis C infections

For hepatitis C, combinations of direct-acting antiviral therapeutics sofosbuvir and velpatasvir, as well as glecaprevir and pibrentasvir can be used to cure the disease by targeting and eliminating the virus. These safe and effective orally administered drugs have been widely available in Australia since 2016.

In Australia, for people covered by Medicare, one course of treatment costs less than $100 to the patient. This drops to just $20 for people with a Healthcare Card.

Director of the Doherty Institute’s WHO Collaborating Centre for Viral Hepatitis, Professor Benjamin Cowie, said that a therapeutics revolution had taken place for hepatitis C.

“Millions of lives have been saved by these hepatitis C treatments globally over the last decade through curing the disease to prevent long-term liver damage.

“There is also the added flow-on benefit of reducing the incidence of hepatitis C within the community and therefore the number of new infections,” said Professor Cowie.

Empowering people living with hepatitis B through life preserving treatments

Each year, 1.1 million people lose their lives from hepatitis B. There is currently no cure for the disease.

Instead, antiviral therapeutic treatments tenofovir and entecavir are used to manage the chronic disease indefinitely to stop or slow down the hepatitis B virus from reproducing. Treatments reduce the severity of infection, reduce transmission risk and importantly prevent disease progression.

Associate Professor Thomas Tu is a leading hepatitis researcher at the University of Sydney, Vice Chair and Secretary of Hepatitis B Voices Australia and Founder of HepBcommunity.org. He is one of the 250 million people worldwide living with hepatitis B and part of the just 2.5% of those receiving treatment.

“These are literally drugs that prevent cancer,” said Associate Professor Tu of the benefits. “They almost eliminate the risk of hepatitis B infection between mother and child during birth, the most common route of transmission.”

“These drugs empower people who live with hepatitis B to maintain a good quality of life. They have been available since the mid-2000s, yet still very few people living with the virus are using them. There is work to be done to improve access to these treatments,” said Associate Professor Tu.

Therapeutic learnings for future pandemics

There are valuable lessons that can be taken from the therapeutic response to viral hepatitis for pathogens of pandemic potential.

1. Investment in therapeutics must equal the investment in vaccines, and they work best in collaboration

While there is still significant investment required to prevent and treat viral hepatitis, the investment in managing the disease so far has been more equal across therapeutics and vaccines than other viruses. For example, during the first 12 months of the COVID-19 pandemic, USD$91 billion was publicly invested globally in vaccines compared to just USD$4.6 billion in therapeutics. 

The response to hepatitis B is a prime example of how vaccines and therapeutics can work together.  

“The universal hepatitis B infant vaccination program commenced in 2000 in Australia and has been incredibly effective. Infant hepatitis B immunisation, including the birth dose, is estimated to have prevented five million future deaths in China alone,” said Professor Cowie.

“However, that only protects those who are not yet living with hepatitis B. Therapeutics play a pivotal role in treating hepatitis B for those already living with it, and preventing loss of life from liver disease and liver cancer, while our vaccination programs protect future generations.”

2. Global disparities in access to hepatitis treatment highlight urgent need for equity

Equitable access to therapeutic treatments is critical in preventing transmission and reducing deaths and serious illness, yet roadblocks remain.

“It’s not ok that low-and middle-income countries with high rates of viral hepatitis infection are unable to access therapeutic treatments, whereas high income countries with lower rates of infection can,” said Professor Cowie.

“Even if we found a cure to hepatitis B, we would have significant challenges eradicating the disease due to access issues,” said Associate Professor Tu.

3. Investment in research and development can fast-track treatments

In Australia, a two-month supply of hepatitis B treatment tenofovir can be purchased from any chemist for less than $40 for people on Medicare.

“Interestingly, tenofovir was originally developed to treat HIV. It was discovered that it was also highly effective for the treatment of hepatitis B, which provided a huge head start in therapeutic development.”

“Having the blueprint in place was critical and this is a learning that can be applied to other pathogens,” said Professor Cowie.

The Cumming Global Centre for Pandemic Therapeutics was established on the premise that treatment solutions can be rapidly adapted to new pathogens of pandemic potential within much shorter timeframes than currently possible.

This can only be achieved through ongoing investment in new science and ideas. See here for more information on how the Centre is funding this next wave of innovation.