On 28th July 2017 the World Health Organization (WHO) will mark World Hepatitis Day. This Day aims to raise global awareness of hepatitis and encourage prevention, diagnosis and treatment.
Oxford-lead STOP-HCV is a Medical Research Council funded consortium which aims to use patient information to establish the most effective and cost effective treatments for patients with Hepatitis C virus.
Professor Ellie Barnes, the University of Oxford
My name is Ellie Barnes and I am supported by the Nuffield Department of Medicine at the University of Oxford and the Medical Research Council. I head up STOP-HCV, which stands for Stratified Medicine to Optimise Patient Outcomes for Hepatitis C viral infection. We are in our fourth year and the Consortium brings together 21 partners from all around the UK; academics, scientists, clinicians, industry. It has been an enormous success, we are into our fourth year. Some of the key outputs have been establishing fantastic patient cohorts, doing very large data generation of viral sequencing and host genomics and integrating that data to give some really powerful outputs and we have been able to adapt to a really rapidly changing landscape over the last four years and I am very proud of that and I think we have established a group of investigators that will be working together for decades to come.
Professor John McLauchlan, the University of Glasgow
My name is John McLauchlan and I am from the University of Glasgow and I work at the MRC Centre for Virus Research. I am one of the founding partners for STOP-HCV and this brings together a number of academic groups and industrial partners to really try to address key questions in treating patients with Hepatitis C and primarily to see what the best treatment options are for these patients so they can clear the virus. So in Glasgow, what we have been doing is really cooperating with the other sites in a number of different ways and one of them is that I am one of the co-Chairs on an another Consortium called HCD Research UK which underpins much of the work that is being carried out by STOP-HCV. As well as that, what we in Glasgow is very much along with our partners in Oxford and in Public Health England is to look at new ways to try and look at the resistance that might develop in patients who are treated with new therapies. So this becomes important in trying to identify which patients would receive better treatments and moving towards areas of thinking about patients who need to be re-treated so these are patients in whom the drugs have not managed to clear the virus and what we are trying to do is entirely optimise the kind of therapies which those patients now should be given so that they will go on to clear the virus.
Professor Will Irving, the University of Nottingham
My name is Will Irving and I am a virologist and I work at the University of Nottingham and the University of Nottingham is intimately involved with STOP-HCV through a number of activities and I think first and foremost, I have been involved together with colleagues in Glasgow in setting up something called HCV Research UK, which is a national cohort of over 10,000 patients with Hepatitis C infection who have enrolled with their written, informed consent and donated to us their biological samples and their clinical data so that we can conduct research studies and all the clinical data is managed and looked after in Nottingham. All the biological samples we have from these patients goes to our biobank in Glasgow. As a result of this, HCV Research UK has supplied data and samples to a new of laboratories that are involved in STOP-HCV that have done some very sophisticated research looking at the host genetic background and what effect that has on Hepatitis C infection, looking at the genetics of the virus, looking at the host immune response and trying to identify markers which will tell us which patients are doing to do well and which patients are at perhaps higher risk of more severe outcomes from the Hepatitis C infection. In addition to HCV Research UK, our virology laboratory contributes to stop HCV looking at the antibody response to infections, so antibodies are part of the host immune response which ideally would neutralise virus and enable an infected patient to eliminate the virus and the lab run by my colleague, Jonathan Ball and Alex Tarr has an interest in understanding how these antibodies work, how they neutralise virus and why in some patients, this neutralisation affect doesn’t seem to happen. So from my prospective, I am extremely grateful to a very large number of patients and the medical staff looking after those patients in 60 different centres across the UK who have contributed their samples and their consent to enable us to partake in really what is a very exciting research study.
Dr Phil Troke, Gilead Science
My name is Phil Troke and I work in the Gilead Medical Department and Gilead Science is a research pharmaceutical company that focuses on diseases of unmet need, in particular we are looking at HIV, also liver disease and around that very much has been Hepatitis C for the last few years and that is where our collaboration work with the STOP-HCV Consortium and also the HCV Research UK Consortium which works very closely with STOP-HCV. So Hep C has moved on incredibly in the last six years and that has been very much working through normal routes, through global clinical trials but through engaging with patient groups and also with clinicians and consortiums such as STOP-HCV to really try and optimise treatment and in particular for the UK patients so that we generate data for support, treatment – giving the right treatment to the right patients in the UK. So there are two collaborations in particular that I would like to highlight; the first one is the BOSON Trial which was a Gilead Trial but run collaboratively with STOP-HCV Consortium that was focused on treating genotype 3 patients which form about 50% of the patients in the UK and really to try and understand what the optimal regime at the time of trial was for those specific patients and really the ability to collaborate with the STOP-HCV Consortium and all the clinical groups that were involved in that and the different centres that enrolled patients from the UK was hugely valuable to UK patients and allowed us to gain a really good understanding about how best to use the drugs in patients. Moving on from there, we have then got what we would call ‘real world data’ which is looking at something and saying actually just in terms of giving access to patients that already exist in the UK are present and what are the right drugs and how do we gain access to the patients most in need. And that was run by NHS England and that was called the SoftPlus NS5A programme and it was aimed at treating patients with decompensated liver disease. So these are patients who have a really high unmet need, that are really struggling and we had other patients who were involved in that programme in 2014 and understand what impact for those who had a transplant for Hepatitis C and a 42% reduction in those patients who had a huge benefit in the UK. Going forward, it is all about extending those collaborations back out even further so we can actually look and say how do we support patients and expanding treatment so the number of patients accessing and getting treatment expands year on year. There are challenges to the NHS in the current austerity measures so how do we support increasing the number of patients within the budget within the NHS and there are a lot of discussions going on and that is really a conversation between clinicians, the NHS generally and NHS England is the payer for many of these patients and it is all about us working together and collaborating and stopping STOP-HCV plays a really big role in helping bring everybody together with those conversations and really understand how we expand treatment for many more patients in the UK could qualify for treatment. And we are in the position at the moment where there are potentially over 200,000 patients with Hepatitis C in the UK and it is how do we enable those who need treatment to get treatment at the right time for them and it is just finding the right conditions and it is all about working together.
Charles Gore, the Hepatatis C Trust
My name is Charles Gore and I am the Chief Executive of the Hepatitis C Trust. It has been really nice to have been involved with STOP-HCV because they have really concentrated on trying to come up with answers that met the questions that patients have, not just the more theoretical research questions but really things that will benefit us and it is about why do I not respond to treatment because if the treatment doesn’t work, patients really want to know, is it something I have done or is it just that I have been unlucky because I have, for example, particular genetic markers in me that just makes treatment not work and maybe that means that I need different combinations of treatment, but there may be examples in which the ways this project will come up with results that will really make a difference and make it better for us as patients.
Dr Tamyo Mbisa, Public Health England
My name is Tamyo Mbisa and I am the head of the antiviral unit at Public Health England and with STOP-HCV, we are involved in the viral genomics structure so pretty much taking methods that have been developed within STOP-HCV on Hep C genome sequencing and trying to implement those in the clinical pathway. At the moment, the project in PHE is really taking those methods, validating them and making them useful for implementation within clinical pathway. The idea is to do that in the next year and launch the service within the NHS to support the delivery of drug of the new DAA’s and hopefully launch the service in 2018. The idea is for whole genome sequencing to give you both Hep C genotyping as well as antiviral resistance in one single assay and at the moment we are using a different assays to do that so this will be an amalgamation of those services and give recommendations for that information at patient entry into clinical care.