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Global Efforts Against HIV/Viral Hepatitis: Eradication and Prevention

Learn about the epidemiology and burden of HIV, HBV, and HCV infections, global initiatives for eradicating viral hepatitis, and the impact on mortality and morbidity. Join the discussion on improving diagnosis, antiviral therapy, and access. Date: Sunday, 17 July 2016. Location: Durban, South Africa. For more info, visit www.iasociety.org

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Global Efforts Against HIV/Viral Hepatitis: Eradication and Prevention

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  1. 3rd International HIV/Viral Hepatitis Co-Infection MeetingHIV/Viral Hepatitis: Improving Diagnosis, Antiviral Therapy and AccessSunday, 17 July 2016Durban, South Africa www.iasociety.org

  2. 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

  3. 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 careand treatment or interventions designed to reduce onward transmission (1% access Rx) Clinical Infectious Diseases 2012; 55(4):507; J ClinVirol 2014;61:20 www.iasociety.org

  4. 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

  5. Global Burden of Viral Hepatitis1990-2013 • 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) • YLDsfrom 0·65 million (0·45–0·89) to 0·87 million (0·61–1·18) • DALYsfrom 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

  6. Global Burden of Viral Hepatitis1990-2013 • 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

  7. 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 • Athird 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 HCV-infected individuals - short duration with minimal monitoring • Requires easy access to affordable diagnostics and generics AIDS 2005;19(6):593; J Acquir Immune DeficSyndr 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

  8. 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

  9. 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

  10. 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 co-infected 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

  11. Thanks for our sponsors and supporters www.iasociety.org

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