Dr Shackel studies the genes that are triggered when hepatitis strikes. He hopes his work will lead to a better and earlier understanding of the likely course of the disease in individual patients.
Hepatitis is an inflammation of the liver caused by infection with a virus. The virus types B and C that lead to chronic conditions are the most common causes of liver scarring or cirrhosis and of liver cancer. It is typically diagnosed after people visit their GPs complaining of extreme tiredness and is picked up through a routine blood test, which can even distinguish the type.
In the past, assessment of the severity of the disease involved a biopsy—extracting a small piece of liver tissue with a huge needle, with the risk of serious consequences. Dr Shackel said the same assessment can now be made quickly and painlessly with an ultrasound, known as Fibroscan, probing the liver’s stiffness.
Dr Shackel – in addition to his research role at Centenary – is a senior staff specialist at the Royal Prince Alfred Hospital’s world-renowned liver unit.
With the latest drugs, Hepatitis C virus can be cleared from better than 80 per cent of people within six months to a year. And there are new treatments on the horizon which may bring that down to less than 20 weeks, Dr Shackel says.
Hepatitis B is also treated with drugs for at least six months and often over many years. But it demands ongoing management, because once infected, you never get rid of it. “While the treatment is effective,” says Dr Shackel, “I tell my patients, ‘You’ll always have the virus, but we can control it’. Understanding when to start, stop and change treatments in individual patients with hepatitis B is one of the major problems with this disease.”
In the laboratory, he is working on a project which will predict the progress of Hepatitis; he sees a time when therapy can become personalised – where doctors are able to separate patients likely to develop cirrhosis or liver cancer from those whose liver disease will be less intense. ”Then we should be able to provide the minimum treatment for a maximum response, giving hepatitis patients a better quality of life and also saving money and medical resources.”
[Dr Shackel’s PhD student Wil D’Avigdor, USYD, who is studying the genetics of Hep C, is currently somewhere between London and Ulaanbaatar in the 2012 Mongol Rally—risking life and limb to raise money for liver research at the Institute. Find his location here and earlier post here.]
**from a tweet by the World Hepatitis Alliance @Hep_Alliance