Professor Foster leads efforts in England to eliminate Hepatitis C virus

The Hepatitis C virus (HCV) is one of the most common forms of viral hepatitis in the UK. It can cause liver scarring (cirrhosis), liver cancer and failure of the liver. The virus has evolved into different genotypes, which have varying prevalence in different populations – and not all respond well to treatment.

What did Professor Foster’s research find?

Professor Foster’s work on the natural history and prevalence of genotype 3 HCV showed that there was a higher prevalence of infection and cirrhosis in immigrants, particularly those from the Indian sub-continent – a group that hadn’t previously been considered high-risk.

Significantly, the Professor’s research also revealed that genotype 3 is a more aggressive strain than previously thought. Up until 2013, therapy for HCV infection involved injectable interferon and tablets with a high number of side effects.

However, Professor Foster’s team found that genotype 3 HCV and cirrhosis responded poorly to interferon-based treatments, highlighting the need for genotype-specific HCV trials.

Defining successful treatment regimes

As a result of this research, biopharmaceutical company Gilead Sciences Inc (who hold the licence for the latest HCV treatment, sofosbuvir) approached Professor Foster to lead an exploratory UK study into improving treatments for genotype 3 HCV. This study identified possible combinations of therapies alongside sofosbuvir to improve treatment response.

These results led to an international phase 3 trial in genotype 3 HCV with a new combination of sofosbuvir/velpatasivir, which had a far better response rate in patients.

Professor Foster also led trials for the alternative therapeutic glecaprevir/pibrentasvir, which achieved a high response rate in patients with genotype 3 HCV without cirrhosis.

These trials were followed by the English Expanded Access Programme that was the first large scale study of antiviral treatments in an unselected population with very advanced liver disease. This study confirmed the efficacy of therapy in this population and, importantly, demonstrated an improvement in life expectancy in people who cleared the virus.

Shaping national and international policy

The results of these trials have shaped national and international guidelines on HCV treatment. Professor Foster’s research also influenced NICE guidelines, helping to identify which population groups should be prioritised in HCV screening. As a result, the NHS now screens migrants from high-risk countries.

In addition, Professor Foster discovered that new mutations – which reduce the effectiveness of antiviral treatments – can be identified through screening. This research helped to shape NHS recommendations on resistance testing.

What has Professor Foster’s research achieved?

In England, the Expanded Access Programme was followed by a general access programme. Professor Foster is the national clinical lead for NHS England’s HCV policy which  aims to eliminate the virus in England. The programme represents the largest ever single NHS investment in specialist services with a investment programme of hundreds of millions.

The programme has been a huge success: over 60,000 patients have been treated, and Public Health England’s 2020 HCV annual report indicated a 20 per cent and 44 per cent fall in deaths and transplant listings for HCV respectively. To date the programme has had a 95 per cent success rate in ‘curing’ patients of the virus.

As Simon Stevens, chief executive of NHS England, states, “It’s not often that the opportunity arises to completely eradicate a disease, but now the NHS is taking practical action to achieve exactly that.”