1 / 19

Behzad Hajarizadeh, Jason Grebely, Gregory Dore Viral Hepatitis Clinical Research Program

The broad patterns of HCV morbidity and mortality across the world. What is the anticipated pattern in Iran?. Behzad Hajarizadeh, Jason Grebely, Gregory Dore Viral Hepatitis Clinical Research Program The Kirby Institute for infection and immunity in society

talia
Download Presentation

Behzad Hajarizadeh, Jason Grebely, Gregory Dore Viral Hepatitis Clinical Research Program

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. The broad patterns of HCV morbidity and mortality across the world. What is the anticipated pattern in Iran? Behzad Hajarizadeh, Jason Grebely, Gregory Dore Viral Hepatitis Clinical Research Program The Kirby Institute for infection and immunity in society The University of New South Wales (UNSW), Sydney, Australia

  2. Outline HCV transmission routs and population at risk Increasing burden of HCV mortality: highlighted or missed? HCV prevalence across the world Liver fibrosis progression in chronic HCV infection Major determinants of current and projected burden due to HCV Broad patterns of HCV morbidity and mortality across the world How will new treatments affect HCV burden? HCV age-specific prevalence in Iran Anticipated pattern of HCV morbidity and mortality in Iran

  3. Increasing burden of HCV mortality: highlighted or missed? Annual age-adjusted mortality rates from HBV, HCV and HIV infections in the United States Fauci, A & Morens, D. NEJM 2012 Ly K, et al. Annals of Internal Medicine. 2012

  4. HCV distribution across the world Global pr. : 2-3% 30-170 million people infected Gravitz L. Nature. 2011 ; Lavanchy D. Liver International. 2009 ; GBD. J Clin Pharm. 2004 ; WHO. Weekly Epi Record. 1999

  5. Liver fibrosis progression in chronic HCV infection HCV-related mortality and morbidity is mainly due to cirrhosis and hepatocellular carcinoma (HCC) Risk of HCV-related cirrhosis increases exponentially by duration of infection There are various factors associated with a higher risk of fibrosis progression Grebely J & Dore G. Semin Liver Dis. 2011

  6. Major determinants of current and projected burden due to HCV Current and projected HCV-related burden reflects temporal HCV incidence and prevalence, HCV disease progression co-factors and HCV treatment uptake. Given slow progression of liver fibrosis, the temporal incidence of HCV is the main determinant of the future burden. Mathematical models have been used to define trends in incidence, which rely on the assumption that current age-specific prevalence reflects the cumulative risk of acquiring infection.

  7. Broad patterns of HCV morbidity and mortality across the world • First pattern • HCV is endemic; High prevalence in all age groups; High incidence • Africa, South Asia, South-East Asia • Second pattern • Low overall prevalence; Low incidence; High prevalence in elderly • Japan, Southern Europe • Third pattern • Low overall prevalence; Low incidence; High prevalence in middle age • The United States, Australia, Northern and Western Europe

  8. HCV incidence and age-specific prevalence in Egypt • HCV pr.: 14.7% • HCV pr. increases with age • 50–59 years age group • M: 46% • F: 31% • HCV inc.: 7/1000 p/y, corresponding to 500,000 new cases per year. Guerra J, et al. J Viral Hep. 2012 Miller FD & Abu-Raddad LJ. Proc Nat Aca Sci. 2010

  9. HCV-related mortality in Egypt HCV is endemic Pr. is high in all ages Inc. is high HCV-related mortality is projected to be 2.5 fold higher in 2020 compared to 1999 More than 20,000 HCV-related deaths occurring in 2020 Deuffic-Burban S, et al. J Hep. 2006

  10. HCV incidence and age-specific prevalence in Japan HCV prevalence: 1.0-1.9% HCV incidence: 1.9 per 100,000 p/y (blood donors) HCV pr. is strongly related to age; exponential increase in over 55 yrs People aged 40 to 69 years account for 86% of infections. Major HCV spread occurred in the distant past (1920s and 1940s [WW II]) Tanaka J, et al. Intervirology. 2004 ; Tanaka J, et al. Intervirology. 2008

  11. HCV-related HCC incidence in Japan High HCV prevalence in elderly Peak HCV incidence occurred several decades ago Low current HCV prevalence, and incidence. HCC incidence peaked in late 1980s to early 1990s and has been decreasing afterwards. Trends in age-standardized incidence of HCC in Osaka, Japan, 1981–2003. Tanaka H, et al. Ann Intern Med. 2008

  12. HCV incidence and age-specific prevalence in the USA • HCV prevalence: • 1.8% in 1988-1994 • 1.6% in 1999-2002 • Peak prevalence shifted from 30-39 yrs in 1988-1994 to 40-49 yrs in 1999-2002 • Major HCV spread occurred in the recent past: • High incidence in the 1970s and early 1980s • Rapid decline from the mid-1980s. Armstrong GL, et al. Ann Intern Med. 2006 ; Williams IT, et al. Arch Intern Med. 2011 ; Armstrong GL, et al. Hepatology. 2000

  13. HCV incidence and age-specific prevalence in Australia HCV prevalence: 1.4% Peak prevalence is 30-39 yrs, at least 10 yrs younger than in the US. HCV incidence increased throughout the 1980s and 1990s with a decline from 2000, initially related to a heroin shortage. The Kirby Institute. Annual Surveillance Report 2012 ; Razali K, et al. Drug and Alcohol Dependence. 2007 ; Amin J, et al. CommDis Int. 2004

  14. HCV-related cirrhosis and HCC in the USA Low prevalence and incidence Relatively higher prevalence in middle age Is following Japanese profile, but with a time lag of 20-30 years. Number of cirrhosis is increasing steadily to a peak level of 1.4 million in 2020 HCV-related HCC should peak in 2019 at 14,000 per year. HCV-related mortality is increasing with 280,000 liver-related deaths within 2020-2029 Davis GL, et al. Gastroenterology. 2010

  15. Patterns of age-specific HCV prevalence and HCV burden Schematic presentations of various patterns of age-specific prevalence of HCV infection and incidence of HCV-related advanced liver disease in four representative countries

  16. How will new treatments affect HCV burden? The sustained virological response (SVR) increased from 55% with pegylated-interferon (PEG-IFN) and ribavirin (RBV) to 70% in the era of PEG-IFN, RBV, and a protease inhibitor (genotype 1 only) IFN-free agents will be available by 2018, with SVR equals to 90%. In 2005, 3% of patients in Europe and the US received treatment, with treatment uptake increasing by only 0.5% per year .

  17. HCV distribution in Middle-East and EMRO countries

  18. HCV age-specific prevalence in Iran Merat S, et al. Int J Inf Dis. 2010 • HCV prevalence: 0.5-1% • Age specific prevalence: • Peak pr. in young or middle age • No constant increase with age • Limited data of HCV incidence • Newly diagnosed HCV cases: • Blood donors: 0.8-1.9/1000 p/y ; relatively steady trend • Surveillance: 5-8/100,000 p/y in one province; relatively steady trend Poorolajal J, et al. J Res Health Sci. 2011 Khedmat H, et al. Hepatitis Monthly. 2009 AminiKafi-Abad S, et al. Transfusion. 2009 Ansari-Moghaddam A, et al. Hepatitis Monthly. 2012

  19. Anticipated pattern of HCV morbidity and mortality in Iran Given high coverage of HBV vaccination in infants and also implementation of catch-up HBV vaccination programs among adolescent, HCV seems to emerge as the leading cause of chronic viral liver disease in the future. Age-specific prevalence of HCV in Iran is more close to that in the US Australia, and Western Europe than the regional countries. Then it is anticipated that the profile of HCV-related burden in Iran is more or less similar to the Western countries (maybe with a time lag of 10-20 yrs). More data needed to identify the profile of HCV-related burden in Iran. Data registry in MOHME has potentials to collect required data for modellings but needs modifications.

More Related