Post on 17-May-2018
Current Epidemiology data on HCV/HBV in Europe
Homie Razavi
First European Roundtable on Hepatitis Cure & Eradication
September 9, 2015
2
Disclosure:
H. Razavi is the Managing Director of CDA and has received no
personal remuneration.
The HCV portion of this work was supported by Gilead Sciences.
The HBV portion of this work was supported by the John C. Martin
Foundation.
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Agenda
• Hepatitis C
• Hepatitis B
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In 2014, there were 3.7 million RNA+ (viremic) HCV infections in the
Europe Union (EU) – 8.5M RNA+ and 13.3M anti-HCV+ in all Europe
Prevalence
(Viremic)
0.0%-0.6%
0.6%-0.8%
0.8%-1.3%
1.3%-2.9%
2.9%-7.8%
Total Infected
(Viremic)
200K-650K
650K-1.9M
0-200K
1.9M-3.5M
Gower, E., Estes C., Hindman, S., Razavi-Shearer, K., Razavi, H. Global epidemiology and genotype distribution of the hepatitis C virus. Journal of Hepatology 2014.
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Austria Belgium CroatiaCzech
Republic Denmark Estonia Finland France Germany Greece
Ireland
Italy
Latvia
Lithuania
Luxembourg
Hungary
NetherlandsPolandPortugalRomaniaSlovakiaSloveniaSweden
United
Kingdom Spain
In EU, G1 (69%) dominates followed by G3 (17%) and G2 (9%)
Prevalence
(Viremic)
0.0%-0.6%
0.6%-0.8%
0.8%-1.3%
1.3%-2.9%
2.9%-7.8%
Total Infected
(Viremic)
200K-650K
650K-1.9M
0-200K
1.9M-3.5M
Gower, E., Estes C., Hindman, S., Razavi-Shearer, K., Razavi, H. Global epidemiology and genotype distribution of the hepatitis C virus. Journal of Hepatology 2014.
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0.00%
0.50%
1.00%
1.50%
2.00%
2.50%
3.00%
3.50%
Italy, Romania, Spain, Germany, Poland , France , UK, Greece and
Portugal account for 85% of total infections in EU
-
200,000
400,000
600,000
800,000
1,000,000
1,200,000 There were 3.7 million viremic HCV Infection in 2014
HCV (viremic) prevalence ranges from 0.1-3% in the region
85%
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0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
HCC
DC
F4
F3
F2
F1
F0
The fibrosis distribution in each country correlates strongly with the
median age of the HCV infected population
51 51 53 49 30 30 46 37 44 57 57 50 50 42 57 48 45 42 44 54 54 41 51 40 38 52 55 42Median
Age
8
-
2,000
4,000
6,000
8,000
10,000
12,000
14,000
16,000
18,000
20,000
Approximately, 80,000 HCV patients are treated in EU annually
Annual number of HCV patients Treated (2013)
0.0%
1.0%
2.0%
3.0%
4.0%
5.0%
6.0%
7.0%
8.0% Treatment Rate (2013)
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Despite the availability of DAAs, the increase in treatment has been
modest in European countries
-
20,000
40,000
60,000
80,000
100,000
120,000
140,000
160,000
2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014
Canada
Australia
France
Germany
Sweden
USA
-
2,000
4,000
6,000
8,000
10,000
12,000
14,000
16,000
18,000
20,000
2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014
Canada
Australia
France
Germany
Sweden
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Austria
Belgium
Bulgaria
Croatia
Czech Rep.
Denmark
Estonia
Finland
France
Germany
Greece
Hungary
Ireland
Italy
Latvia
Lithuania
Luxembourg
Netherlands
Poland
Portugal
Romania
Slovakia
Slovenia
Spain
Sweden
UK
Malta
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
0% 1% 2% 3% 4% 5% 6% 7% 8%
Dia
gn
os
is R
ate
Treatment Rate (2013)
Increased screening and treatment is required to make a significant
impact on HCV prevalence in EU
(2014 Tx Rate)
(2014 Tx Rate)
(2014 Tx Rate)
Bubble size
corresponds to HCV
Prevalence Rate
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Agenda
• Hepatitis C
• Hepatitis B
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In 2014, an estimated 4.1 million HBsAg+ individuals were in EU
Analysis based on literature search. Data has not been validated with
individual countries.
Prevalence
0.0%-1.2%
1.2%-2.0%
2.0%-5.0%
5.0%-10.0%
10.0%-21%
Total Infected
24K-82K
82K-188K
0-24K
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Romania, Poland, France, UK, Spain, Italy, Greece and Germany
account for 85% of all HBV infections in EU
0
200,000
400,000
600,000
800,000
1,000,000
1,200,000
0.00%
0.50%
1.00%
1.50%
2.00%
2.50%
3.00%
3.50%
4.00%
4.50%
5.00%
There were 41 million HBsAg+ individuals in 2014
The prevalence of HBsAg ranged from 0.2-4.4% in EU
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The Percentage of one year olds receiving 3 doses of HepB
immunization has increased to 90% in EU
0
10
20
30
40
50
60
70
80
90
100
He
pa
titi
s B
(H
ep
B3
) im
mu
niz
ati
on
(%
)
EU Average AUT BEL BGR HRV CYP
CZE EST FRA DEU GRC IRL
ITA LVA LTU LUX MLT NLD
POL PRT ROU SVK ESP SWE
Source: WHO - Global Health Observatory Data Repository
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Elimination of HBV among infants is a feasible goal for any country
• Cuba achieved zero new HBV infections among infants in 2014
» Screen all pregnant women
» Use locally produced Hepatitis B immune globulin (HBIG) and treatment in
the last trimester
» Start immunization of infants at births and treat with HBIG if HBsAg positive
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In Conclusion:
• Relative to other regions, the total number of HCV and HBV infections is
low
• Unfortunately, treatment remains low in the region (below what is
required to achieve elimination)
• Elimination of HBV (zero new cases) is feasible in EU but national
strategies are required
• A significant reduction in HBV related HCC and decompensated
cirrhosis among adults is also feasible in EU through treatment
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More to Follow in the next few months:
• Detailed HCV Epidemiology data by country & region
• Interactive HCV strategy web-based model
• HBV epidemiology data by country & region
• HCC cases attributed to HBV and HCV
• Liver transplants attributed to HBV and HCV
• Web-based model for HBV eradication among infants
• Web-based model for HBV treatment among adults