The arrival of new drugs, the direct-acting antivirals, with their high efficacy, better safety, and fewer unwanted effects, has revolutionized the treatment of hepatitis C virus infection. The ANRS is interested in evaluating the efficacy of these new drugs in real-life conditions, but also in the outcome of patients after eradication of the virus.
The ANRS supports research on hepatitis B, notably through clinical trials. HBV Cure was put in place via the creation of a coordinated action (AC 34). Today, several drugs are under development for the treatment of hepatitis B and hepatitis D, and clinical results are already available. The ANRS envisages supporting a biomedical research project in patients co-infected with hepatitis B and hepatitis D.
ANRS CO22 HEPATHER
The new direct-acting antivirals are highly effective: 12 weeks after discontinuation of treatment, viral RNA is undetectable in over 80% of cases. However, not all patients respond positively to these treatments and a small proportion are or become resistant to direct-acting antivirals. Other cirrhotic patients develop liver tumors despite eradication of the virus. The ANRS is interested in these research subjects and supports ancillary studies of the cohort ANRS CO22 HEPATHER, which now includes the patients of cohorts ANRS CO12 CirVir and ANRS CO23 CUPILT.
Monitoring of resistance
Virological relapse was seen in some patients receiving direct-acting antivirals: viral RNA becomes detectable again a few weeks after discontinuation of treatment. Analyses have shown that most of these patients carried viruses resistant to one or more direct-acting antivirals. Monitoring of resistance will enable measurement of the incidence of HCV resistance to direct-acting antivirals and to characterize the resistance profiles of patients with treatment failure.
Viral hepatitis and cancer risk
In cirrhotic patients, even after eradication of the hepatitis C virus or when hepatitis B virus is controlled, the risk of developing a primary liver tumor (hepatocellular carcinoma or cholangiocarcinoma) remains. One study is comparing the characteristics of these tumors at the time of diagnosis and prognosis, as a function of the treatment received (patients who responded to direct-acting antivirals, to dual therapy, or to triple-drug therapy, and patients showing no virological response), so as to improve the liver cancer screening policy for these patients.
Failure of dual therapy with direct-acting antivirals: evaluation of new options
Some patients infected by hepatitis C virus do not respond to dual therapy with direct-acting antivirals and the study ANRS HC34 REVENGE is evaluating in these patients a new therapeutic option combining grazoprevir/elbasvir, sofosbuvir, and ribavirin.