Fighting Hepatitis B and liver cancer in West Africa

In Africa, liver cancer kills about 300 000 people every year, and that number is set to double by 2050 unless steps are taken to provide treatment for HBV.

The EU-funded project PROLIFICA is aimed at developing a screening and treatment programme for tackling HBV infection in West Africa, and it will evaluate whether such a programme can help to reduce the incidence of liver cancer.

Professor Mark Thursz at the Imperial College of Science, Technology and Medicine coordinates PROLIFICA. He says liver cancer is one of the main causes of early death in West Africa, especially for men.

People in West Africa are not generally tested for HBV, and the infection itself does not cause any symptoms, so most people who are infected do not know it. By extension, there is no warning of cancer risk and no preventive treatment, so those who do get liver cancer generally die within a few weeks of diagnosis.

“Liver cancer caused by HBV develops slowly over a number of months,” Thursz says. “If it is caught early enough, it can be effectively treated, but in Africa and many parts of Asia where this kind of cancer is common, the disease usually only comes to light when it is at a very advanced stage.”

Progress in prevention

At about the mid-way point in the project, Thursz reports the PROLIFICA screening programme has been widely accepted in West African communities and uptake has been very high.

“We are just about to complete the initial stage of the project, which has involved the identification of patients with HBV,” Thursz says.

In addition, using blood and urine samples from patients with cancer and healthy control patients, PROLIFICA researchers have been able to identify chemical metabolites that indicate a high risk of liver cancer. Individuals identified as HBV-positive are being treated with an anti-HBV drug and will be monitored both for HBV status and signs of cancer.

PROLIFICA researchers are also developing a new test to detect liver cancer that will allow them to assess these patients on a regular basis. The test will be potentially patentable and marketable, but Thursz says project partners are committed to making it available at a low price for use in resource-limited settings.

The team will know if they have been successful in two years, when enough long-term data has been amassed on the effectiveness of the anti-HBV drug treatment and its impact on the development of liver cancer.

“There is a real need to address the burden of liver disease imposed by this virus,” Thursz says. “With over 350 million people worldwide suffering from chronic HBV infection, the number who might benefit from this work is enormous.”

And the potential economic impact could also be significant, with a healthier population capable of working and supporting their families and a reduction in the cost of healthcare for terminal cancer patients.

“If we can show that our screening and treatment programme is effective and economically viable, then we expect public health authorities in other parts of Africa and Asia to adopt similar schemes,” says Thursz.

The project will also deliver a new set of guidelines targeting adoption by the World Health Organisation’s Global Hepatitis Programme, he says.

PROLIFICA has received EUR 3 million in EU funding and runs from 2011 to 2016. The project was funded under the FP7 Coordinated Call for Africa (FP7-AFRICA-2010), which brought together three themes – Theme 1: Health; Theme 2: Food, Agriculture and fisheries, and Biotechnology; and Theme 6: Environment (including climate change) – to jointly address some of the S&T objectives of the Joint Africa-EU Strategic Partnership, particularly on “Water and Food Security” and “Better Health for Africa”.

4th February 2014 - World Cancer Day