The value of hepatitis-related data collection – Dr. Clemens Richter explains
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Dr. Clemens Richter has been an internist-infectiologist at Rijnstate hospital in Arnhem since 1997. He is specialised in treating HIV, hepatitis, tropical diseases, immune diseases and other infectious diseases and recently won the “Mednet Top Physician 2011, Internal Medicine” award. He is the chairman of the Hepatitis B/Hepatitis C (HBV/HCV) Working Group which is a collaboration of the Dutch Association of HIV-treating Physicians (NVHB) and Stichting HIV Monitoring (SHM). The group was set up in 2010 to review broadening the range of hepatitis-related data collected by SHM and to prepare data collection for the new HCV medications now becoming available. During an interview, Dr Richter kindly agreed to explain his ideas on the value of collecting data related to hepatitis infection. |
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Could you please explain why it is necessary to collect data on HBV and HCV co-infections in HIV-infected patients?
We are actually missing quite a lot of data. We know that there are a number of patients with co-infections in the Netherlands but we don’t know their actual history. There are a lot of questions that still need to be answered. For example, how many patients have liver fibrosis, cirrhosis or hepatocellular carcinoma? How many are being treated? How many aren’t being treated? How many are waiting for the new medications before starting treatment? How many have been successfully treated? How many have relapsed?
We also need data on acute HCV infections in the Netherlands, such as the distribution of hepatitis genotypes in all treatment centres throughout the country and not only for large centres.
I believe a specific database on HCV co-infections would also be extremely useful in selecting patients for studies involving new HCV medications. Patients could, for example, be selected on genetic background and liver disease (stage of fibrosis) to see if that has any influence on treatment as well as the efficacy of these medications. Also, we could look at risks for complications with treatment. Through all this data we would be able to learn and this could have an impact on improving patient care.
What type of data is collected?
The SHM database now has pages specifically for hepatitis co-infections. Detailed data can be collected on general information, such as a patient’s genetic background, age and sex, and we can now add data specific to hepatitis B and C co-infections. This includes clinical data and laboratory data, particularly liver enzymes, albumin and prothrombin levels which indicate liver function, as well as HBV DNA and HCV RNA characteristics as well as HBV and HCV genotypes. We can also link specific results of ultrasounds, CT scans, MRI scans, liver biopsies or fibroscans, which could provide useful insights.
Through having this data available, what impact does it have on the treatment of HBV and HCV co-infections in HIV-infected patients?
Treating co-infections is usually a complicated procedure. By having data available we will be able to analyse what the best practices should be. For example, treatment may have been started too late in some patients and through data analysis we will be able to see that, learn from it and be more alert in the future. Ideally we will be able to formulate standards for the Netherlands related to treatment and follow-up, such as developing specific treatment regimens for patients with co-infection.
For HCV infections, new drugs will be available in April. The new data available on their use in HIV co-infected patients is limited. Therefore it is important to collect data on these new medications so that we can get an overall picture of treatment response and treatment toxicity. Availability of data will allow us to improve treatment protocol. And it’s important to collect data for the whole of the Netherlands to get the required volume of data to be able to draw sound conclusions.
Is similar hepatitis-related data being collected for non-HIV-infected patients?
A database for mono-infected patients is currently in a pilot phase. It is being set up by physicians at the AMC in Amsterdam, Erasmus in Rotterdam and Rijnstate in Arnhem, using the experience of SHM’s co-infection database. At a later stage, once this database is up and running, we will be able to compare data of mono- and co-infected patients.