Page 20 - CIBEREHD2016-ENG

Epidemiology, Prevention and Treatment
of Hepatitis Virus Infection
Coordinator: Xavier Forns Bernhardt
In 2016, programme 3 has made some significant progress in different fields. It is important to stress that some of the headway was made in the framework of the Strategic Plan for Hepatitis, including cooperation with groups belonging to other programmes.
The data registered in HEPA-C (a joint CIBER-AEEH register) has meant that data on the efficacy and
safety of large real-life cohorts could be compiled. The efficacy results are excellent and highly similar to the ones reported in the register tests published on the combinations of medications (both for the set of patients and for the ones with liver cirrhosis). As well as the elimination of the virus, another of the aims
of the treatment is to prevent or reduce the incidence of decompensations. In a study that included over 200 patients with clinically significant portal hypertension and cirrhosis it was observed that after PVR the hepatic vein pressure dropped from 15.8. to 13.5 mmHg (average change -2.3 mm Hg), with a considerable percentage of patients reaching a portal pressure gradient under 10 mm Hg (and thus clear of any risk of decompensation).
In cooperation with the hepatic oncology programme, it has been observed that treatment with DAA
in patients with hepatocellular carcinoma (CHC) in remission could be associated with a higher CHC recurrence rate. This finding has generated a great deal of controversy and further multi-centre studies have been got under way to go more deeply into this area.
Another of the aspects on which work has been done in 2016 is the subtyping of samples of patients of the HEPA-C cohort, in which over 35 centres in Spain have cooperated. They also proceeded to standardise in-depth sequencing to detect resistant mutants in regions NS3, NS5A and NS5B. In fact, 165 samples from patients with virological failure in different patterns,. have been processed: In respect of the diagnostic use of high-resolution Hepatitis C virus subtyping by massive-sequencing, the exploitation of European patent (EU PATENT No. WO2015001068 A1) has been consolidated, which will entail royalties for the CIBER.
In the field of epidemiology, an analysis has been made of the hepatitis B and C chronification rates in children of infected pregnant mothers, to analyse the factors involved in this and evaluate whether there are biomarkers which could identify the mothers at greatest risk of vertical transmission.
As aspects of translational research, we should stress: 1- the study of the induction in the expression of Angiopoyetin-2 in the liver of patients with hepatitis C, and its correlation with the state of the illness and the capacity of different genomic regions of the HCV; 2- the study of the polymorphisms of Aurora Kinase B activity in the progression of hepatic fibrosis in patients with chronic hepatitis C. 3- validation of the system for analysis of RNA-HCV at points of care, 4- the study of the role of favipiravir for potential treatment of hepatitis C, taking advantage of its effect on the viral quasispecies (lethal mutagenesis).
In the area of hepatitis B it is worthwhile mentioning a study of cohorts which included over 600 patients treated with entecavir and tenofovir and who were monitored for over 5 years to assess the effect of treatment on clinical events.
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