Objective
The specific aims of this European concerted action were the following:
- to assess the natural course and outcomes of patients with chronic HBV infection.
- to construct prognostic indices of chronic hepatitis B aiming for rational application of therapeutical approaches, namely antiviral drugs and/or liver transplantation.
- to study viral antigen expression in liver and serum and relate it to markers of the specific and general immune response in the liver and blood.
- to perform meta-analysis on completed and ongoing clinical trials on antiviral treatment of chronic HBV infection.
- to construct prognostic indices for treatment-induced events in chronic HBV-infection.
- to determine the therapeutic gain in survival after liver transplantation for chronic viral hepatitis.
- to assess the efficacy of hepatitis B immunoglobulin in the prevention of recurrence of viral hepatitis after liver transplantation.
Viral hepatitis, in particular chronic viral hepatitis due to hepatitis B and hepatitis C virus, is an important health problem in Europe. In the high-endemic countries like Greece, Italy, Spain and Portugal there are at least 2.5 million virus carriers; in the low-endemic countries of North-Western Europe chronic viral hepatitis predominantly affects haemophiliacs, homosexuals and drug addicts, but 30 percent of virus carriers do not belong to specific risk groups.
Chronic viral hepatitis appears to run a variable natural course. Subjects from North and Central European countries usually become infected during adult life, often through sexual practice, have high levels of hepatitis B virus (HBV) and core protein (HBeAg) in the serum, and after a variable number of years clear HBeAg and HBV from the serum with remission of the inflammation of the liver. In Southern Europe, intrafamilial spread is common giving rise to infection early in life. Clearance of HBeAg occurs frequently, but HBV-replication with active liver disease can persist in antiHBe-positive patients. The existence of an emerging variant strain of the virus has been demonstrated. Moreover, hepatitis D virus (HDV) superinfection is particularly common in Southern Europe both in relation to intrafamiliar spread as well as to drug addiction. Conceivably, the ongoing pandemic of human immuno deficiency virus (HIV) infection, which is spreading predominantly among homosexuals in North-Europe and among drug addicts in Southern countries, might modify the epidemiological, clinical and virologic patterns of the disease. The pathobiology of chronic viraemia is only partly understood and further study of immunology, environmental factors (lifestyle, virus-virus interaction) and molecular biology could elucidate why a small proportion of infected persons develop chronic viral hepatitis.
All types of chronic viral hepatitis are now amenable to treatment by antiviral agents or liver transplantation. Alpha-interferon is being tested widely and will be licensed in Europe. This treatment is costly and only effective in a minority of patients. Similarly, the very costly therapy of liver transplantation is increasingly applied to patients with liver failure due to chronic viral hepatitis, although the effectiveness of this treatment modality appears uncertain. The evaluation of the modification of the natural history by such treatments is impossible by the incomplete knowledge of the prognosis without treatment. Furthermore, indications for intervention should be based on both prognosis and the expected benefits of the treatment. Results of antiviral drugs and liver transplantation vary widely from centre to centre, probably related to different characteristics of the patients and variable modes of treatment. In order to restrict treatment to subgroups of patients with chronic viral hepatitis who are most likely to benefit from it, cooperative research in both assessing prognosis as well as benefits and risks of treatments is mandatory.
In addition to the studies on epidemiology, antiviral therapy and liver transplantation, the Eurohep programme includes a section on pathobiology aiming to diffuse standardized laboratory methodology for measurement of virus or virus antigens, and to facilitate basis research on blood or tissue samples from patients in the clinical research programmes.
Fields of science (EuroSciVoc)
CORDIS classifies projects with EuroSciVoc, a multilingual taxonomy of fields of science, through a semi-automatic process based on NLP techniques.
CORDIS classifies projects with EuroSciVoc, a multilingual taxonomy of fields of science, through a semi-automatic process based on NLP techniques.
- medical and health scienceshealth sciencesinfectious diseasesDNA viruseshepatitis B
- medical and health scienceshealth sciencespublic healthepidemiologypandemics
- medical and health sciencesbasic medicineimmunology
- medical and health sciencesclinical medicinetransplantation
- medical and health sciencesbasic medicinepharmacology and pharmacypharmaceutical drugsantivirals
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3015 GD Rotterdam
Netherlands