Hepatitis

Infectious hepatitis is caused by a number of genetically unrelated viruses of which the most important are hepatitis A, B, and C. Hepatitis A infections spread by a fecal-oral route, hepatitis C is bloodborne, and hepatitis B can be transmitted via blood and sexual fluids. Although hepatitis A and B are vaccine-preventable and hepatitis C is curable, they remain important contributors to disease burden globally and in the US. Of particular interest to researchers at the Yale School of Public Health and our colleagues throughout the Yale community are the prevention and treatment of HCV. It is estimated that there are 130– 150 million chronic cases of HCV worldwide, including 2.7– 4 million in the U.S., which makes it the leading cause of liver diseases. Although an indolent chronic disease, HCV mortality in the US exceeds that for any other single infectious agent. The major route of HCV transmission in most of the world is unsafe, unsterile injections among people who use psychotropic and addictive drugs. Preventing new infections and expanding treatment for those already infected could drastically reduce or even eliminate HCV since there is no host other than humans.

Robert Heimer, professor of epidemiology, and his collaborators study aspects of the biology, epidemiology, prevention, and treatment of HCV. In the laboratory, the processes and materials involved in the preparation and injection of illicit drugs are investigated to determine the most likely causes of the transmission of infectious HCV and the best methods to reduce such transmission. These findings are used by harm reduction and other prevention programs that assist drug users in their attempts to avoid HCV infection or prevent its further spread. Based on bio-behavioral data collection in populations of people who use drugs we study HCV incidence and the behaviors, psychological factors, and social forces that influence transmission. These findings are used to implement and scale up prevention efforts. As effective HCV treatment expands, we are developing approaches to reduce HCV reinfection among those cured.

Gregg Gonsalves, assistant professor of epidemiology, is interested in policies related to access to medications. Treatment for HCV has exploded in the last half decade with the development of multiple classes of directly acting antiviral agents. While combinations of these agents are proving pan-genotypic and curative, they are also very expensive. Dr. Gonsalves and colleagues are interested in policies that increase or limit medication access. As co-director of the Yale Law School/Yale School of Public Health Global Health Justice Partnership, he has led a project to investigate access to the new directly acting antivirals in US state prisons, worked to make access to the clinical data from the key HCV studies available for independent scrutiny by researchers in a lawsuit against the FDA, which sought to have clinical trial data released for secondary analyses, and supervised a project producing a report and policy discussions on the steps needed to expand global access and address the high prices of these drugs in the US.

Secondary and research faculty with interests in some or all of the above aspects of hepatitis prevention and treatment: Frederick Altice in Internal Medicine, Elijah Paintsil in Pediatrics, Andre Sofair in Internal Medicine, and Lauretta Grau a Research Scientist in EMD.

• YSM Viral Hepatitis Program