Eradicating Hepatitis C and HIV: Leading Scientists Discuss Prospects for Next Ten Years

Since October, the Oxford Martin School has played host to a string of discussions in the seminar series Health in the 21^st century: what’s new? Last Thursday, two leading virologists, Dr John Frater and Dr Ellie Barnes, gave an engaging and thought-provoking talk on Hepatitis C and HIV, and the challenges facing researchers who hope to eradicate these viruses in the next ten years. The talk is available to watch here.

Pathogenic viruses, such as Hepatitis C and HIV, threaten the lives of millions each year. The experts were called upon to discuss whether they could envisage the necessary steps that must be taken in our efforts to eradicate the viruses by the mid-2020s. The conclusions gained from the discussion were polarised; Hep C eradication seems likely within the 10 years, but HIV is seen by many to be an altogether trickier customer. Many researchers still consider HIV to be incurable, despite recent headline-grabbing ‘cures’ coming off the back of the ‘Berlin patient’ Timothy Ray Brown, and the putative eradication of disease in children treated aggressively after contracting the virus. However, the discussion was a reminder that in a world of unbounded scientific breakthrough, hope should not be lost.

The first to speak was Dr Barnes, a Principal Investigator at the Institute of Emerging Infections at the Oxford Martin School. Her research group focuses on a revolutionary new vaccine for Hepatitis C, and their work lies at the forefront of the virology field. More than 180 million people worldwide are infected with Hepatitis C, the transmission of which is commonly associated with intravenous drug use. This RNA virus mainly affects the liver and can lead to many serious complications such as liver cancer and liver failure. However many of those who are infected are asymptomatic, meaning they show no symptoms of illness. This complicates the progress of eradication as this group of infectious individuals will continue to spread the disease without seeking treatment.

Despite this, Dr Barnes was confident that within the next 10 years we are likely to see the eradication of Hep C. She explained that treating the asymptomatic population was possible with active sampling. Furthermore, despite the current course of treatment being so expensive (a staggering £18-35,000 per person), it is likely to fall considerably in future years as a wide range of alternative drugs are currently passing through scientific and clinical trials. There is a lot of money to be made in an accessible treatment to Hep C, and so pharmaceutical companies are scrambling to develop and market an effective drug or vaccine. Additionally, Dr Barnes introduced the Hep C T-cell vaccine that was in development within her research group. They will be moving on to their first efficacy trials in humans next year and are very excited to see the results.

Dr Barnes argued that the barrier to Hep C eradication will not be within diagnosis, treatment or vaccination but will be in a lack of political willpower. Historically, the most potent factor in disease eradication has been concerted government action, as highlighted by the recent investment of resources and manpower in the fight against Ebola. Research had been slowly moving forward for 30 years until the epidemic struck this year and a vaccine was produced within months. Sadly, it often takes a crisis such as an epidemic before the political willpower is sufficient to provide the funds and resources necessary to combat a disease.

Dr Frater, also a Principal Investigator at the Institute of Emerging Infections, then moved the discussion on to HIV and where the next 10 years is likely to take us. Human immunodeficiency virus (HIV) causes the acquired immunodeficiency syndrome (AIDS). AIDS sees the immune system fail, meaning the patient is susceptible to minor infections that become life threatening when the immune system cannot provide any defence. Dr Frater described how the world is now entering a new phase of HIV where new infections are still occurring but rapid progression to AIDS and early mortality is far less likely. If antiretroviral treatment is started early enough, it can be so effective that the patient will have the same life expectancy as that of a non-infected person. Therefore, there is a growing population of people who will be taking antiretrovirals for their whole life.

Antiretroviral treatment is arguably the greatest medical innovation of the last 30 years. The combination treatment appears to remain effective against a virus with a high level of mutation and so a high chance of developing drug resistance. Furthermore it reduces the viral load of a patient to a level where they are no longer infectious. In fact it has been argued that antiretrovirals are as effective as condoms in stopping the spread of the virus. Controversially it has been proposed that non-infected people should have access to the antiretrovirals in order to protect themselves when having un-protected sex. This was argued to be highly desirable for some high risk people, such as sex workers, who are not always able to ensure they have safe sex.

Dr Frater admitted that most in the field do not believe that eradication of HIV was likely. However he argued that we should not lose hope. He suggested that the key in curing HIV lay in rapid administration of antiretroviral drugs after infection. Furthermore he proposed the ‘shock and kill’ method of awakening the virus from latency and then administering drugs to kill it was potentially an effective treatment. Dr Frater suggested there may not be not be a light at the end of the tunnel yet for HIV cures but there is light within the tunnel, referring to the great success treatment has had in allowing patients to live healthy lives.

This discussion highlighted two viral diseases that are likely to see very different levels of progress in the next 10 years. Hep C has the potential for eradication in the near future provided concerted political action. In contrast, despite public and political awareness of the HIV epidemic, a fundamental lack of an effective vaccine or cure is unlikely to be solved in the next decade. These two cases illustrate the importance of effective cross-over and collaboration between scientists and politicians in our efforts to eradicate deadly diseases.