Why hepatitis B remains a huge global health problem

According to the World Health Organisation, Hepatitis B (HBV) affects around 300 million people worldwide and accounts for an estimated 820,000 deaths a year. On World Hepatitis Day, we spoke to Crick group leader Philippa Matthews about the challenges of controlling the disease and reaching people affected.

Philippa speaking at a podium in an open part of the Crick

Philippa Matthews speaking at the Crick's Public Engagement Day

International targets to eliminate HBV have been set for 2030, an ambitious goal that researchers argue will require wider use of antiviral therapies and new approaches to diagnosing and treating the infection.

These are challenges only too familiar to Philippa Matthews, head of the Crick’s HBV Elimination Laboratory. She joined the institute in 2021 to further her group’s research into the pathology of HBV, aiming to develop evidence to improve outcomes for people living with HBV infection and to enhance progress towards global targets.

“There are major barriers to tackling HBV effectively,” explains Philippa. “One of the most significant is in our understanding of the biology underlying infection and persistent disease. Some people with a chronic infection will never develop severe symptoms or require additional treatment, but others can develop life-threatening liver scarring and cancer. We do have drugs that can suppress infection, but we still don’t have a cure.”

Philippa’s lab is examining these different outcomes of HBV infection and working to understand at the molecular level, how the infection takes hold and interacts with the immune system, why some people become severely ill, and how we can identify and treat them to reduce risks.

They are working in partnership with local centres in London and across the UK, and also with collaborators in Uganda, South Africa and Kenya, where HBV infection is more common.

While we have effective interventions in the form of antiviral medication, and also vaccines to prevent infection, we’re currently only delivering these to a tiny fraction of the people that need them.
Philippa Matthews

By sequencing and studying the genetic code of the virus, they hope to gain insights into the interactions between the virus and its human host. They are also exploring the immune responses that determine the ability of the body to clear infection, and how the interaction between the virus and the patient might influence responses to treatment.

WHO estimates that only around 10% of all people estimated to be living with long-term HBV infection have had a diagnosis, and that only just over 20% of people diagnosed were receiving treatment. However, international bodies including WHO are reviewing guidelines, with consideration for changing recommendations to reach more people with interventions.

“This is especially important because while we have effective interventions in the form of antiviral medication, and also vaccines to prevent infection, we’re currently only delivering these to a tiny fraction of the people that need them,” adds Philippa.

As we learn from people and communities most affected by HBV, there is increasing evidence of many barriers to effective care, including social stigma surrounding the disease. Previous studies by Philippa’s group and others have found that in endemic areas, there is a lack of knowledge of HBV and in some places, there is no local word to describe HBV infection. There’s also evidence of misconceptions about HBV infection, transmission and treatment.

Hepatitis B virus - a red sphere covered in red hair-like structures with yellow tips

Hepatitis B virus

The hope is that with increased research and awareness, hepatitis might be talked about more and start to be destigmatised, in a similar way to progress made against HIV, where improvements in treatments and preventative drugs mean in many cases the infection can be kept under control and people lead healthy lives.

“HBV has never had that injection of political advocacy, funding, energy and education that’s gone into other transmissible diseases like TB and HIV,” says Philippa.

“We can learn so much from the experiences and approaches tackling these conditions. It will require sustained effort across research and clinical care, and international collaboration, to achieve impact where the burden of disease is highest.”

The theme for this year’s World Hepatitis Day is ‘We’re not waiting’, highlighting the call of patients and communities for access to rapid testing and treatment, but also the need for urgent action to bring resources, advocacy, education and research to make meaningful advances towards elimination.

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