Current Epidemiology data on HCV/HBV in Europe

Homie Razavi

First European Roundtable on Hepatitis Cure & Eradication

September 9, 2015

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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