Researchers and clinicians in Oxford have provided fresh insights into how some people with chronic hepatitis B (CHB) can be cleared of the disease, as part of a national initiative to better use NHS patient data to tackle emerging health issues.
It is hoped that the research, the first study on CHB under the auspices of the National Institute for Health Research (NIHR) Health Informatics Collaborative (HIC), could lead to a better understanding of the immunology of the virus and help lead to improved monitoring and treatment of patients.
The NIHR-HIC brings together all 20 NIHR Biomedical Research Centres (BRCs) and their associated and partner NHS hospital trusts to utilise routinely collected clinical data to tackle important therapeutic areas.
Infection with hepatitis B virus causes potentially life-threatening liver disease and is considered a major global health problem. There are 292 million people chronically infected with the virus worldwide, eight times more than those who are HIV-positive. Almost 900,000 people die each year from hepatitis B-related complications such as cirrhosis and liver cancer.
An international target to eliminate hepatitis B by the year 2030 has been agreed, meaning advances in the diagnosis, monitoring and treatment of the infection are urgently required.
The NIHR Oxford BRC-supported study explored why a small proportion of people with CHB ‘clear’ the virus, whether they were on medication or not, while the overwhelming majority have to live with it for the rest of their lives.
“At the moment, we are not able to predict which patients will ‘clear’ CHB infection,” said Dr Philippa Matthews (pictured), Associate Professor at the University of Oxford’s Nuffield Department of Medicine, who led the study.
Of 553 individuals in the Oxford area with CHB, follow-up clinical data were available for 319. Of these, 13 were cleared of the protein biomarkers used to detect the virus – whether they were on anti-hepatitis B drugs or not.
“Studying the routinely-collected patient data, we tracked two protein biomarkers that are used to monitor chronic hepatitis B infection, looking for clues as to why some people clear the virus. If we can identify and understand the immunological factors that underpin that ‘clearance’, it could pave the way for us to better understand the different outcomes of infection, and also to develop better monitoring and new treatments,” Dr Matthews, who is also funded by the Wellcome Trust, said.
“What has been crucial here has been the use of routinely-collected electronic clinical data. We have shown that this has a huge potential for collating large datasets that can help to inform advances in patient care – including a more personalised approach. We’ve seen that it works here in Oxford, and now we hope to be able to use this process in the other NIHR HIC centres.”
Initially, five NIHR HIC centres, which serve a population of around 20 million people, focused on delivering high-quality data in five key therapeutic areas: acute coronary syndromes, ovarian cancer, viral hepatitis, renal transplantation and intensive care. More emerging health issues have been included in the initiative, with data now being collected for patients with prostate, breast, colorectal and lung cancer, as well as a wider range of infectious diseases.