Download Slides - View the full AIDS 2016 programme

3rd International HIV/Viral
Hepatitis Co-Infection Meeting
HIV/Viral Hepatitis:
Improving Diagnosis, Antiviral Therapy and Access
Sunday, 17 July 2016
Durban, South Africa
www.iasociety.org
Introduction
• Epidemiology of HIV, HBV & HCV infections
• Global Burden of Viral hepatitis
• WHO aims for eradication of viral hepatitis
Lancet. 2012;380 (9859):2095; BMC Medicine 2014;12:159; WHO; 2014 [EB 134/36]; Lancet 6 July 2016
www.iasociety.org
Epidemiology: HIV, HBV & HCV infections
• 240 million persons are chronically infected with hepatitis B virus
• 130-150 million persons with hepatitis C
• 34 million persons with HIV
• 70% of global 34 million people with HIV live in sSA

Corresponding to regions of high HBV and HCV endemicity
HIV/HBV/HCV Mortality (annual death rate) (www.worldmapper.org in Nov 2012)
•
Majority of persons with chronic hepatitis B and hepatitis C

Unaware of their infection (95%)

Do not benefit from clinical care and treatment or interventions designed to
reduce onward transmission (1% access Rx)
Clinical Infectious Diseases 2012; 55(4):507; J Clin Virol 2014;61:20
www.iasociety.org
Global Burden of Disease
Global Burden of Disease study: 1990-2013
• Viral hepatitis is responsible for approximately 1.45 million deaths/yr
• HIV/AIDS: 1.3 million/yr
• Malaria: 0.9 million/yr
• Tuberculosis: 1.3 million/yr
Viral hepatitis is now the 7th leading cause of mortality worldwide
• Mortality due to viral hepatitis has increased by 63% since 1990
• Persistent lack of global awareness of the severity of the problem
• Lack of commitment to combat and ultimately eliminate the disease
Lancet. 2012;380 (9859):2095; BMC Medicine 2014;12:159; WHO; 2014 [EB 134/36]; Lancet 6 July 2016
www.iasociety.org
Global Burden of Viral Hepatitis
1990-2013
• Viral hepatitis is a leading cause of death and disability worldwide
• Globally, viral hepatitis deaths increased from 0·89 million (95%
uncertainty interval [UI] 0·86–0·94) to 1·45 million (1·38–1·54)
• YLDs from 0·65 million (0·45–0·89) to 0·87 million (0·61–1·18)
• DALYs from 31·7 million (30·2–33·3) to 42·5 million (39·9–45·6)
• Mortality and morbidity mainly due to hepatitis B and C infections

96% [95% UI 94–97] of mortality and 91% [88–93] of DALYs in 2013
• Unlike most communicable diseases, the absolute burden and relative
rank of viral hepatitis increased between 1990 and 2013
Lancet 6 July 2016
www.iasociety.org
Global Burden of Viral Hepatitis
1990-2013
• Burden of disease was not equally distributed worldwide
• Hepatitis-related mortality highest (≥33.50 deaths per 100 000 pop/year)

Oceania, western sub-Saharan Africa and central Asia
• In absolute numbers, east Asia and south Asia

Greatest number of hepatitis deaths (52% of the total number of deaths)
• Unlike HIV, which primarily occurs in low-income countries (mainly sSA)

58% hepatitis deaths occurred in upper-middle-income countries and
high-income countries
Lancet, 6 July 2016
www.iasociety.org
Burden of Liver Disease
• Liver disease due to chronic hepatitis B and C is a significant
cause of morbidity and mortality in HIV infected individuals

•
Liver-related mortality 2x higher in HBV/HIV than in HCV/HIV co-infection
Without appropriate diagnosis and treatment

A third of those chronically infected with viral hepatitis will die as a result of
complications of chronic liver disease: Cirrhosis, liver failure and HCC
• Global antiretroviral therapy scale-up should limit HBV-related liver
disease, through dual antiviral activity

HBV mono-infected individuals: frequently undiagnosed with limited access
to therapy
• New pangenotypic DAA regimens offer >90% cure to all HCVinfected individuals - short duration with minimal monitoring

Requires easy access to affordable diagnostics and generics
AIDS 2005;19(6):593; J Acquir Immune Defic Syndr 2000;24(3):211; J Inf Dis 2013;208(9):1454;
South Afr Med J 2012; 102:157; World J Hepatol 2010; 2: 65
www.iasociety.org
WHO: Eradication of Viral Hepatitis
WHO aims by 2030
• 90% reduction in new cases of chronic hepatitis B and C
• 65% reduction in hepatitis B and C deaths
• 80% of treatment eligible persons with chronic hepatitis B and C
infections treated
Globally, this will require
• Development and Implementation of National Guidelines for the
Prevention and Treatment of Viral Hepatitis
• Development and Implementation of National Surveillance Strategies
• Access to sustainable and affordable diagnostics and therapeutics

•
Enabling identification and linkage to care
Effective utilisation of existing infrastructures for delivery of care
www.iasociety.org
Eradication of Viral Hepatitis
Ultimate elimination of HIV and viral hepatitis will require an effective
partnership between:
• Affected communities
• Professional and community organisations
• Governments and National Departments of Health
• Researchers and health professionals
• Pharmaceutical companies
www.iasociety.org
Meeting Objectives
• To review the latest therapeutic developments in viral hepatitis B and C
• To identify challenges and successes in scaling up diagnosis,
screening, antiviral treatment and prevention of viral hepatitis in HIV coinfected persons
• To identify how to optimize outcomes and costs to achieve sustainable
and equitable access to these therapies globally
• To learn from successful models, such as novel voluntary licensing
agreements and map a path toward scaling up of viral hepatitis
treatment programmes in low-, middle- and high-income settings
• To advance the agenda for viral hepatitis eradication by assembling key
stakeholders for a face-to- face discussion of major barriers & solutions
www.iasociety.org
Thanks for our sponsors and supporters
www.iasociety.org