2015-2030年乙肝和丙肝疾病负担：漫长而曲折的道路

StephenW

2015-2030年乙肝和丙肝疾病负担：漫长而曲折的道路

预计到 2030 年新的 HBV 和 HCV 将下降，但 HCV 和 HBV 的新 HCC 病例将上升，与 HBV 肝脏相关的死亡人数预计将增加 30%

EASL 国际肝脏大会 2022，伦敦，2022 年 6 月 22 日至 26 日

马克·马斯科里尼

在 166 个国家进行的慢性 HBV 和病毒血症 HCV 感染的单独建模研究预测，到 2030 年，全球 HBV 和 HCV 感染的发病率（新诊断）将下降 [1]。但模型称，未来十年，与 HBV 和 HCV 相关的新肝细胞癌 (HCC) 病例将在全球范围内上升。

美国疾病分析基金会中心的研究人员 [2] 每年更新 166 个 HBV 和 104 个 HCV 马尔科夫模型，以预测这些肝炎流行率的变化。如果当前的诊断、治疗和减少危害的努力在未来保持稳定，这些模型使用特定国家/地区的输入来估计未来的疾病负担。这些模型以 2015 年的数据为基准，展望 2030 年。

从 2015 年到 2020 年，新诊断和治疗的 HCV 病例在 2017 年到 2018 年期间在全球范围内都出现了激增，然后到 2020 年下降到略低于 2015 年的水平。同年，全球只有不到 10% 的符合条件的 HBV 感染者感染了治疗。如果当前趋势保持不变，预计 2015 年至 2030 年大多数地区流行的 HBV（HBsAg 阳性）感染和 HCV 病毒血症感染将下降，原因是 HBV 疫苗使用量增加和人们死亡，以及 HCV 因良好的 DAA 治疗。在欧洲，流行的 HBV 将下降 25%，HCV 将下降 48%。到 2030 年，由于移民，北美流行的 HCV 将下降 48%，但 HBV 将上升 4%。预计非洲 HCV 流行率下降主要反映了埃及强大的抗 HCV 计划，这往往会使结果有些模糊。在大洋洲，由于治疗率低，预计 HCV 感染会增加。

如果当前趋势保持不变，新的 HBV 和 HCV 感染（发病率）应该会下降到 2030 年。欧洲的 HBV 发病率有望下降 78%，拉丁美洲和加勒比地区下降 61%，北美下降 55%，部分原因是 HBV 疫苗接种。由于获得 HBV 疫苗的机会较少，非洲和大洋洲的 HBV 发病率下降速度将较慢。

由于在欧洲范围内扩大 HCV 治疗和减少危害计划、减少医院传播和完善的血液控制程序，大多数研究地区的新 HCV 感染应该下降（例如，欧洲 44%）。但是该模型认为，到 2030 年，北美的 HCV 发病率将上升 18%，因为我们面临持续的阿片类药物危机，这导致美国新感染病例的增加，这转化为北美的增加（Jules：我会在今天，老年人的数量与前几年相似，因此两者都导致新感染的增加——年轻人和老年人）。

如果当前趋势保持不变，到 2030 年，由 HBV 和 HCV 引起的新 HCC 病例数量将总体攀升。发言人说，引述 Homie Razavi 的话说，HCV 或 HBV 感染者患 HCC 的风险实际上与每天抽一包烟的人患肺癌的风险相同。 “HCC 的风险非常大，而且在社区中未被报道和讨论不足”。但大部分增长将来自亚洲、非洲、拉丁美洲和加勒比地区。欧洲、北美和澳大利亚的 HCV 相关 HCC 病例将减少，因为这些大陆广泛使用了 HCV 治疗。预计各大洲 HBV 相关的 HCC 病例都会增加。 HCV HCC 相关病例在我们治疗率较高的一些大洲（例如欧洲、北美）正在减少，但在世界许多其他地区，预计会增加 -

模型预测，到 2030 年，与 HBV 肝脏相关的死亡人数将增加 30%，除非诊断和治疗大幅增加，否则每个地区的死亡人数都会上升。但全球与 HCV 肝脏相关的死亡人数应该会下降 5%，“但不会下降很多”，其中北美下降 75%，欧洲下降 49%，澳大利亚下降 47%。相比之下，在拉丁美洲和加勒比地区，与 HCV 肝脏相关的死亡人数有望激增 45%。如果您将埃及排除在等式之外，您会看到非洲与 HCV HCC 相关的死亡人数增加，而不是您在下图中看到的 3% 减少。


疾病分析中心的研究人员表示，尽管这两种感染都有一些有希望的趋势，但全球在预防和治疗 HBV 和 HCV 感染方面仍有许多工作要做。例如，他们指出，消除 HBV 垂直传播和在出生时及时接种 HBV 仍然是优先事项。 “强有力的支持和政治意愿，”他们强调，“对于全球和区域应对 HBV 和 HCV 的挑战是必要的。”

EASL：评估消除 HBV 和 HCV 的全球进展 - 偏离轨道 - (06/23/22)

StephenW

The disease burden of hepatitis B and hepatitis C from 2015 to 2030: the long and winding road

New HBV and HCV Projected to Decline Thru 2030, But New HCC Cases Will Rise for both HCV & HBV, HBV liver related deaths expected to increase by 30%

EASL International Liver Congress 2022, London, June 22-26, 2022

Mark Mascolini

Separate modeling studies of chronic HBV and viremic HCV infection in 166 countries projected that incidence (new diagnoses) of HBV and HCV infection will fall globally through 2030 [1]. But new cases of hepatocellular carcinoma (HCC) related to both HBV and HCV will rise globally over the next decade, the models said.

Researchers from the Center for Disease Analysis Foundation in the United States [2] annually update 166 HBV and 104 HCV Markov models to project changes in rates of those hepatitis epidemics. Using country-specific input, the models estimate future disease burden if current diagnosis, treatment, and harm reduction efforts hold steady into the future. The models used 2015 data as a baseline and looked forward to 2030.

From 2015 through 2020, newly diagnosed and treated HCV cases both jumped globally in 2017-2018, then decreased through 2020 to levels a little lower than 2015. Over the same years, fewer than 10% of eligible people with HBV infection across the world got treated. If current trends hold, prevalent HBV (HBsAg-positive) infections and HCV viremic infections are forecast to decline from 2015 to 2030 in most regions, due to for HBV increased vaccine use and people dying, and for HCV due to good DAA treatments.. In Europe prevalent HBV will drop 25% and HCV 48%. In North America prevalent HCV will fall 48% but HBV will climb 4% through 2030 because of immigration. Predicted falling HCV prevalence in Africa mainly reflects Egypt’s strong anti-HCV program, which tend to obscure the results a little. In Oceania HCV infections are expected to increase due to low treatment rates.

New infections with HBV and HCV (incidence) should fall through 2030, if current trends hold. HBV incidence is on track to decline 78% in Europe, 61% in Latin America and the Caribbean, and 55% in North America, partly because of HBV vaccination. Declines in HBV incidence will be slower in Africa and Oceania because of lower access to HBV vaccines.

New HCV infections should drop in most regions studied (for example, 44% in Europe) because of widening HCV therapy and harm reduction programs across Europe, declining nosocomial transmission and great blood control procedures. But the model sees HCV incidence rising 18% in North America through 2030 because we have an ongoing opioid crisis which is resulting in an increase in new infections in the USA which translates into that increase in North America (Jules: I would add new infections in older people persists at similar levels today as in previous years so both are contributing to increased new infections – among young & old).

Numbers of new HCC cases attributable to both HBV and HCV will climb overall through 2030 if current trends hold. The speaker said Homie Razavi was quoted as saying that the risk of developing HCC for people with HCV or HBV is actually the same as the risk for developing lung cancer for a person smoking a pack of cigarettes a day. “The risk for HCC is really huge and its unreported and underdiscussed in the community”. But most of that increase will come in Asia, Africa, and Latin America and the Caribbean. HCV-related HCC cases will drop in Europe, North America, and Australia because of widespread HCV therapy on those continents. HBV-related HCC cases are expected to increase in all continents. HCV HCC-related cases are declining in some continents where we have high treatment rates  - Europe, North America for example – but in many other parts of the world its expected to increase -

Modeling projects that HBV liver-related deaths will jump by 30% through 2030, rising in every region unless diagnosis and treatment increase substantially. But HCV liver-related deaths should decline by 5% globally “BUT not by a whole lot”, including falls of 75% in North America, 49% in Europe, and 47% in Australia. In contrast, HCV liver-related deaths are on track to balloon 45% in Latin America and the Caribbean. If you take Egypt out of the equation you would see an increase in Africa in HCV HCC-related deaths as opposed to the 3% decrease you see in graph below.


Much work remains in preventing and treating HBV and HCV infection globally, Center for Disease Analysis researchers said, despite certain promising trends with both infections. For example, they noted, elimination of vertical HBV transmission and timely HBV vaccination at birth remain priorities. “Strong support and political will,” they stressed, “are necessary to globally and regionally combat the challenge of HBV and HCV.”

EASL: Evaluation of Global Progress towards HBV and HCV elimination - off track - (06/23/22)

References
1. Razavi-Shearer D, Blach S, Gamkrelidze I, et al. Thedisease burden of hepatitis B and hepatitis C from 2015 to 2030: the long andwinding road. EASL International Liver Congress 2022, London,June 22-26, 2022. Abstract OS050.
2. Center for DiseaseAnalysis Foundation. https://www.devex.com/organizations/center-for-disease-analysis-foundation-cdaf-132936   

StephenW

https://www.natap.org/2022/EASL/EASL_82.htm

油腻大叔

回复 StephenW 的帖子

2030年估计是消灭不了乙肝了

StephenW

回复 油腻大叔 的帖子

我同意. 如果我们忽略 FDA，功能性治愈仍然是可能的.

lancas

先完成阶段性目标比较靠谱~~~

StephenW

回复 lancas 的帖子

FDA 没有批准联合治疗的策略，其中组合中的单个药物可能无法获得 FDA 批准.