HBV治疗未能达到全球目标

StephenW

HBV Treatment Fails to Meet Global Targets
Only 5% of hepatitis B patients received antiviral therapy in 2016


    by Molly Walker, Staff Writer, MedPage Today
    March 26, 2018

Action Points

    Only an estimated one in 20 patients with hepatitis B worldwide received antiviral therapy for their illness in 2016.
    Note that less than half of infants received timely birth dose vaccination, and less than 1% of mothers with a high viral load received antiviral therapy in 2016.

Only an estimated one in 20 patients with hepatitis B worldwide received antiviral therapy for their illness in 2016, a modeling study found.

Of the estimated 292 million people living with hepatitis B virus (HBV), there were 94 million individuals eligible for treatment, but only 4.8 million (5%) actually received it, reported The Polaris Observatory Collaborators.

Moreover, less than half of infants received timely birth dose vaccination, and less than 1% of mothers with a high viral load received antiviral therapy in 2016, the authors wrote in the Lancet Gastroenterology & Hepatology.

Reduction of hepatitis B in infants, via mother-to-child transmission, was characterized as important by the authors, because "most HBV infections in infants become chronic, which is the leading source of new chronic HBV infections." Moreover, they cite the World Health Organization (WHO) Global Health Sector Strategy on Viral Hepatitis, which hopes to eliminate hepatitis B and hepatitis C worldwide by 2030. Targets for hepatitis B include:

    90% global coverage of three-dose infant vaccination by 2020
    Timely birth dose vaccination in 50% of infants by 2020, and in 90% by 2030
    Prevalence in children age 5 years of 1% by 2020, and 0.1% by 2030
    Diagnosis of 90% of people infected with HBV by 2030
    Antiviral treatment of 80% of those diagnosed and eligible for treatment by 2030

The group cited recent estimates from the Lancet or the WHO, which estimated 248 million or 257 million individuals with HBV infection. But the authors added that "these reports were limited by their calculation of averages using a combination of robust and representative studies, studies done in different age groups, and studies done at different time points." They added that these were historical estimates that did not consider the effects of vaccination and efforts to prevent perinatal transmission of HBV.

Using a combination of data from prior studies as well as expert interviews, this group developed models for 120 countries, of which 78 used data approved by experts. They estimated that global prevalence of hepatitis B surface antigen (HbsAg) was 3.9% (95% uncertainty interval 3.4-4.6) or around 292 million infections (95% UI 251,513,000-341,114,000) in 2016.

However, only 29 million (10%) of the 292 million HbSAg-positive patients were diagnosed in 2016. An accompanying editorial by Geoffrey Dusheiko, MD, of King's College Hospital in London, and Kosh Agarwal, MD, of University College London, characterized these figures as "disconcerting," given that a diagnostic test for hepatitis B "has long been available."

"There is a need to raise awareness of HBV to the same level as that of HIV and a pressing prerequisite for inexpensive, innovative, point-of-care nucleic acid testing for HBV DNA, paired with hepatitis C virus RNA and HIV RNA assays," the editorialists wrote. "The incidence of new chronic HBV infections will continue to increase unless appropriate prevention at birth is applied, and deaths will increase in unvaccinated adults unless large increases in screening and linkage to care are implemented."

The authors estimated that 1.8 million infections were in children age 5 years, with a prevalence of 1.4%. They added that while they estimated only 46% of infants received a timely birth-dose vaccination, 87% of infants younger than 1 year did receive the three-dose HBV vaccination schedule. Weighting by births of mothers with high viral loads, the authors found less than 1% received antiviral treatment in 2016.

Five countries -- China, India, Nigeria, Indonesia, and the Philippines -- accounted for more than half of hepatitis B infections worldwide, and five countries (Nigeria, India, Indonesia and the Democratic Republic of the Congo) accounted for more than half of estimated infections in children age 5 years.

Of note, the authors said that of the 16 countries with the greatest number of infected children, only China had timely-birth dose vaccine coverage of 90% or higher, while 10 of these countries had not yet introduced timely birth dose. They added that "these figures show the importance of robust prophylaxis schedules."

But they also said that the largest strides towards global elimination of HBV were in infant vaccination, with 94 of the modeled countries estimated to have met the 2020 target of 1% prevalence among children age 5, and 46 estimated to have met the 0.1% prevalence target for 2030.

Study limitations included that while it was available for 90% of the estimated number of infections globally, some countries where data was extrapolated had large populations, and some regions had only a few countries with data. In addition, while national estimates may be correct, there may be regional variations, as the study did not account for certain populations with a higher prevalence than the general population, such as immigrants, indigenous peoples and nations, people who inject drugs, and sex workers.

This study was supported by the John C. Martin Foundation.

StephenW

HBV治疗未能达到全球目标
2016年仅有5％的乙型肝炎患者接受抗病毒治疗

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    由莫莉沃克，职员作家，MedPage今天
    2018年3月26日

动作要点

    全球仅有20例乙肝患者中有一例在2016年接受抗病毒治疗。
    请注意，少于一半的婴儿接受及时的接种剂量疫苗接种，并且在2016年接受抗病毒治疗的母亲中，只有不到1％的病毒载量较高。

一项建模研究发现，全球仅有20例乙肝患者中有一例在2016年接受抗病毒治疗。

据北极星天文台的合作者报道，估计有2.92亿人患有乙型肝炎病毒（HBV），其中有9400万人有资格接受治疗，但实际上只有480万人接受了治疗。

此外，作者在Lancet Gastroenterology＆Hepatology上写道，不到一半的婴儿接受及时的接种剂量疫苗接种，并且在2016年接受抗病毒治疗的母亲中，低于1％的病毒载量较高的母亲。

由于“大多数婴儿乙型肝炎病毒感染变成慢性病，这是新的慢性HBV感染的主要来源，所以通过母婴传播来减少婴儿乙型肝炎的特征是这些作者的重要特征。”此外，他们引用世界卫生组织（WHO）关于病毒性肝炎的全球卫生部门战略，希望在2030年之前在全球消除乙型肝炎和丙型肝炎。乙型肝炎的目标包括：

    到2020年，全球覆盖率达到全球覆盖率的三分之一
    到2020年，50％的婴儿及时接种出生剂量疫苗，到2030年将达到90％
    到2020年，5岁儿童的患病率为1％，到2030年为0.1％
    到2030年诊断90％感染HBV的人
    到2030年，80％的被确诊和有资格接受治疗的患者接受抗病毒治疗

该组织引用了柳叶刀或世界卫生组织最近的估计，估计有2.48亿或2.57亿人患有HBV感染。但作者补充说：“这些报告受限于他们使用强健和有代表性的研究，不同年龄组的研究以及在不同时间点进行的研究的平均值计算。”他们补充说，这些是历史估计，没有考虑疫苗接种的影响和努力预防围产期HBV传播。

利用先前研究的数据和专家访谈的结合，该小组为120个国家开发了模型，其中78个使用了专家批准的数据。他们估计2016年全球乙型肝炎表面抗原（HbsAg）流行率为3.9％（95％不确定性区间为3.4-4.6）或约2.92亿感染率（95％UI 251,513,000-341,114,000）。

然而，在2016年诊断出的2.92亿HbSAg阳性患者中，仅有2900万（10％）被诊断出来。伦敦国王学院医院的Geoffrey Dusheiko医学博士和伦敦大学学院的Kosh Agarwal博士的随行评论这些数字“令人不安”，因为对乙型肝炎的诊断测试“早已有了”。

“有必要提高对乙肝病毒的认识，使之与艾滋病病毒的水平保持一致，同时也是与HBV丙型肝炎病毒RNA和HIV RNA检测配对的便宜，创新，即时检测核酸检测的先决条件， “编辑们写道。 “新的慢性HBV感染的发病率将继续增加，除非出生时采取适当的预防措施，而未接种疫苗的成年人的死亡率会增加，除非大幅增加筛查和与护理的联系。”

作者估计，5岁以下儿童有180万人感染，发病率为1.4％。他们补充说，虽然他们估计只有46％的婴儿接受及时的出生疫苗接种，但87％的1岁以下的婴儿确实接受了三剂接种乙肝疫苗的时间表。作者发现高病毒载量母亲的出生体重，发现2016年接受抗病毒治疗的小于1％。

五个国家 - 中国，印度，尼日利亚，印度尼西亚和菲律宾 - 占全球乙型肝炎感染的一半以上，五个国家（尼日利亚，印度，印度尼西亚和刚果民主共和国）占一半以上估计5岁以下儿童感染率。

值得注意的是，作者说，在受感染儿童数量最多的16个国家中，只有中国的及时出生疫苗接种率达到了90％或更高，而其中有10个国家尚未引入及时的出生剂量。他们补充说，“这些数字显示了强有力的预防时间表的重要性。”

但他们还表示，在全球消灭乙肝病毒方面取得的最大进展是婴儿接种疫苗，其中94个建模国家估计达到2020年5岁以下儿童的1％流行率目标，46个估计达到0.1％流行率2030年的目标。
研究局限性包括尽管全球感染数量的90％可用，但一些数据外推的国家人口众多，有些地区只有少数国家有数据。 此外，虽然国家估计可能是正确的，但可能存在区域差异，因为该研究没有考虑某些人群患病率高于普通人群的情况，如移民，土着人民和国家，注射吸毒者和性别 工人。

这项研究得到了约翰C.马丁基金会的支持。