Name: Andrea Cox
Institution: Johns Hopkins University
Location: Baltimore, MD, USA
Could you tell me a little bit about your research and what it entails?
My laboratory focuses on HCV vaccine development and investigates human immune responses to HCV, HBV, and HIV, including mechanisms through which these chronic viral infections stimulate and evade immune responses. Chronic HCV and HBV infection substantially increase the risk for liver failure and liver cancer and prevention of HBV through vaccination has already been shown to reduce rates of liver cancer. One important goal of our research has been to determine what immune response allows effective control of HCV infection in order to generate a vaccine that induces a protective immune response that prevents people from becoming chronically infected. I am excited to be a lead investigator on the first prophylactic HCV vaccine trial ever implemented in a population of people at risk for HCV infection.
How did you come to be interested in viral hepatitis?
As an infectious disease specialist and an immunologist, I was struck by how successfully HCV evades the immune response. Infected people have huge amounts of virus in their blood, but the immune system does progressively less over time to combat the virus and virtually ignores the virus despite the large amounts of virus circulating throughout the body. Solving the fascinating mystery of how the virus manages to be so stealthy enhances design of a vaccine to prevent HCV infection. This research may also help explain why people infected with the virus often have few symptoms and are frequently unaware that they are infected.
What do you see as the biggest accomplishment in your field in the past few years?
All in our field would agree that the development of highly effective and easily tolerated directly acting antivirals (DAAs) that cure almost all who are treated is the biggest accomplishment of the field over the last decade. However, a second important achievement in the field is the first trial testing a preventative HCV vaccine is people at risk for infection. A trial that can assess the efficacy of a vaccine in preventing HCV infection had never been performed prior to this trial. Results are expected in the fall of 2018.
What do you see as the main challenges for research in your field in the coming years?
Although DAAs are an enormous step forward, achieving global control of HCV infection remains a substantial challenge. The number of new HCV infections is rising dramatically in the United States and comprehensive screening programs are rare in the most highly endemic regions of the world. As a result, many HCV-infected people don’t even know they are infected, even in the United States. Patients unaware they are infected will not receive treatment and remain at risk for transmitting the infection to others. Successful control of HCV infection will most likely require a combination of large scale global screening to identify those with infection, treatment, and prevention strategies that include the use of a prophylactic HCV vaccine.
What personal career achievement are you most proud of? Why? I am very proud that we have for the first time moved a vaccine to prevent HCV infection into trials of people at risk for infection. It is challenging to complete a trial in those at risk for infection, but testing a vaccine in an at-risk population is critical in determining if the vaccine protects. This is a critical step forward in the quest for a safe and effective preventative HCV vaccine.