The long and winding road

Viral hepatitis is one of the leading causes of death worldwide. In fact, 90% of this burden is attributed to the sequelae of infections of HBV and HCV.¹ In view of this, the WHO established a goal in 2015 to eliminate HBV and HCV infections by the year of 2030.¹ With commitment to both prevention and treatment by increasing the reach of vaccination programs and launching screening and treatment initiatives, elimination is a feasible goal.¹

Study design

To evaluate the progress of this battle against HBV and HCV infection, Devin Razavi-Shearer, an analyst at the Center For Disease Analysis Foundation, has conducted a study to estimate the natural history and future disease burden at the global and continental level through 2030.2 2015 was selected as the baseline to align with the WHO target.² The primary outcomes of the study were the incidences of both acute and chronic infections of HBV and HCV, along with mortality and the incidence of HCC within the respective populations.²

Results from literature review and Delphi expert interviews were integrated into country-specific Markov models.² The PRoGReSs model has been applied to the HBV dataset (n=166), while the Bright model has been applied to the HCV dataset (n=110).² Where data was unavailable, regional averages were applied to the total population of the country.²

The harrowing impacts of HBV

At current trends, both ongoing infections and new infections are projected to decline through 2030.² Despite a global expected decrease of 11% in HBV prevalence (from 282 million to 247 million), the prevalence in Africa is expected to remain relatively constant with an expected increase in HBsAg-positivity incidence in North America as a result of immigration.² Incidence of CHB cases per year is expected to decline by 43% (from 1,459,000 to 827,000 cases) across all continents as a direct result of the availability of HBV vaccinations.² The improvement is less evident in Africa and Oceania due to the lack of access to birth dose vaccinations.² HBV-related HCC cases are expected to increase across all continents by 34% (from 682,000 to 912,000) cases annually with the greatest prevalence in Africa and Asia.² The mortality of HBV is expected to increase by 39% annually (from 850,300 to 1,109,500) deaths, if there are no substantial improvements in the rates of diagnoses and treatment.²

The encouraging results of HCV

The prevalence of HCV is expected to decrease by 15% globally (from 64 million to 54 million).² With that said, the incidence of CHC cases per year is expected to decline by 7% (from 1,521,000 to 1,409,000) globally, but the incidences in North America are expected to increase due to limited access to harm reduction programs.² The incidence of HCV-related HCC is expected to increase by 9% (from 202,000 to 220,000) cases annually with increases in Asia, Oceania, and South America.² Mortality of HCV is expected to increase by 3% annually (from 284,000 to 293,000).² Notably, Egypt’s efforts in HCV viremic infection have provided a significant reduction in HCV incidences and HCV mortality, offsetting the raising HCV burden of the African continent and the global scale.²

Conclusion

The study concluded that viral hepatitis would remain a public health threat on both the global and continental levels through 2030 according to current trends.³ Without additional interventions, it is estimated that almost 12 million individuals will die from HBV- and HCV-related deaths.³ Strong support and political will are necessary to globally and regionally combat the challenge of HBV and HCV.

^{Glossary: CHB: Chronic hepatitis B; CHC: Chronic hepatitis C; HBsAg: Hepatitis B surface antigen; HBV: Hepatitis B virus; HCC: Hepatocellular carcinoma; HCV: Hepatitis C virus; WHO: World Health Organization}