The recent recognition by the WHO of the weight of viral hepatitis in global morbidity and mortality, the advent in the developed world of revolutionary treatments, and the availability of new screening and diagnostic strategies have, in recent years, modified the profile of research on hepatitis in the developed countries and in resource-limited settings. Some resource-limited countries have set up or activated more effective national programs in the fight against hepatitis. In this evolving landscape, research is absolutely crucial.
For hepatitis C, the aim is to develop a strategy of simplified care of patients, with short oral treatments (a few weeks) that are well tolerated and above all pangenotypic, and which enable the envisioning of a nonspecialized follow-up.
The great challenges regarding hepatitis B are still the absence of curative treatment, very limited access to the few effective drugs, like tenofovir, the definition of patient care, and follow-up criteria.
The study ANRS 12202 is reassessing the prevalence of hepatitis B and hepatitis D 25 years after the first described epidemics, so as to identify the HBV genotypes associated with the hepatitis D genotypes. The results will indicate the extent of the infection by these two viruses, differentiate past infections (without replication) from "active" hepatitis D, with a view to treatment, and will compare the strains of 2008 with the ancestral strains of 1984-1987.
Burkina Faso is one of the few African countries to have really heeded the problem. The Ministry of Health has expressed a wish to draw up a plan rooted in solid epidemiological data on HBV, HCV, and HDV infections. The principal aim of the study ANRS 12270 is to estimate, for the first time, the national prevalence and distribution of HBV, HCV, and HDV infections in Burkina Faso. The plan also is to determine the factors associated with HCV infection and the contribution of the historical iatrogenic transmission of HCV to the present epidemic.
The principal aim of the study ANRS 12289 is to estimate, for the first time, the national prevalence and distribution of HBV, HCV, and HDV infections in Cameroon. The plan also is to determine the factors associated with HCV infection and the contribution of the historical iatrogenic transmission of HCV to the present epidemic.
Two projects are evaluating the population impact of the hepatitis B epidemic. One, a health economics study, is focused on the effects of the infection on households and health systems (ANRS 122356). The other, which is under way in Cambodia, is evaluating the clinical consequences of HBV infection (ANRS 12348).
Prevention of mother-to-child transmission is one of the main challenges of epidemic prevention and control: vaccination at birth, as recommended by the WHO, and validation of an antiviral treatment of the mother during pregnancy are research priorities for the ANRS. One study of prevention by tenofovir administered to the mother is under way in Cambodia (TaProhm ANRS 12345). Another approach consists in testing the administration of tenofovir to the child from birth, to prevent transmission by breastfeeding (ANRS 12359). The WHO recommendation of vaccination at birth is hard to implement in resource-limited countries. One operational study of vaccination at birth is ongoing in Cameroon (ANRS 12303).
In view of the need for large-scale treatment of hepatitis in resource-limited countries, the ANRS has started several relevant studies (Cambodia ANRS 12345, eight African countries HBV ANRS 12327, Cameroon HCV ANRS 12336)
AC ANRS 12311, the first clinical trial in Africa with the latest generation antivirals, the direct-acting antivirals, administered according to the different HCV subtypes, is under way in three countries in West Africa (Cameroon, Senegal, Ivory Coast). The clinical results will be coupled with a cost-efficacy evaluation of this treatment in the context of resource-limited countries (ANRS 12343).
A large operational research program in Egypt (Project Hepnile, ANRS 12 332) is evaluating the efficacy and effectiveness of new drugs for hepatitis C in the context of nationwide treatment of the disease in a resource-limited country.
Two cohorts will furnish answers to several clinical, human sciences, and social questions. One is being conducted in Ivory Coast in HIV-infected patients recently co-infected by hepatitis (ANRS 12277 Preco-CI), and the other is in Cambodia in patients infected by HBV (ANRS 12 348).