Blood borne viruses

Lead Research Organisation: University College London

Abstract

Infectious diseases are still major causes of deaths and illnesses worldwide. In our Blood Borne viruses programme we have focussed on hepatitis C virus (HCV) and Human Immunodeficiency Virus (HIV). These are the blood borne viruses with the greatest global burden of deaths and illness. Our studies are in line with the strategic priorities of the World Health Organization. Our results change guidelines, policy and practice across the age range. Most of our infection trials involve collaborations with partners and networks worldwide. We pursue collaborations which have high global impact and in which we can shape the science now and in the future, drive the research agenda, and play a key role in the research trial design, conduct and analysis. Examples of the impact of our research include:
1. license approval of new antiretroviral treatments for children with HIV, with resulting improved outcomes
2. a package of affordable anti-infective medicines, which reduces mortality in those presenting with AIDS
3. preventing HIV infection by taking just one antiretroviral pill a day.
Together these trials contribute to the WHO targets of eliminating AIDS globally.

Technical Summary

Infectious diseases remain major causes of mortality and morbidity worldwide. In the Blood Borne viruses (BBV) programme we have focussed on hepatitis C virus (HCV) and Human Immunodeficiency Virus (HIV), the blood borne viruses with the greatest global burden of mortality and morbidity. Chronic BBV infections also have indirect effects, by increasing the risks or adverse consequences of non-communicable diseases. It therefore remains essential that prevention efforts across the spectrum of key BBVs continues, especially if the WHO targets for global elimination are to be achieved. Our studies are aligned with the major strategic priorities of the World Health Organization, and results are expected to, and have change guidelines, policy and practice across the age spectrum.
In particular, the advent of new highly effective direct acting antivirals against hepatitis C provides a unique opportunity for large strategic trials to identify how these drugs might be used best to support the elimination agenda and increase access, in low-and-middle-income countries and in the challenging “hard-to-reach-and-treat” populations. Our research objectives are to exploit new, short effective oral regimens to test strategies which might successfully cure patients whilst minimising drug exposure and/or course duration, including stratified medicine approaches, in large randomised trials. We also aim to develop a trial to cure hepatitis C virus in pregnant women living with HCV and prevent vertical HCV transmission.
In HIV infection, the prevention trials that we have led have played a major role in reducing new HIV infections, and we have implemented novel designs to improve efficiency in both the vaccine (MAMS designs) and self-testing (electronic randomisation and follow-up) areas. We have also completed a large randomised trial in late HIV presenters, identifying an adjunctive package of prophylaxis which reduced mortality after starting treatment by 25%. We continue to address relevant questions to the management of HIV-infected children, particularly focussing on questions relating to the efficacy, toxicity and pharmacokinetics of antiretroviral drugs in new fixed dose combination solid dispersible formulations, using new ratios and following WHO-recommended weight-bands. However, the continued and improving success of treatment of vertically infected HIV-infected children surviving into adolescence as a consequence of antiretroviral therapy, has to be balanced with the poorer treatment outcomes in adolescents, and emphasises the need to investigate more acceptable, less toxic, treatment and prevention strategies to improve long-term health outcomes in this population, including the utility of long-acting injectable antiretrovirals. This objective will be achieved through the design, conduct and analysis of large randomised trials in low and middle-income settings.

Publications

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