专家称世卫组织制定的消除乙肝病毒目标无法实现

StephenW

专家称世卫组织制定的消除乙肝病毒目标无法实现
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专家称世卫组织制定的消除乙肝病毒目标无法实现

最近的一项研究表明，目前根除乙型肝炎病毒 (HBV) 的努力，包括疫苗接种、筛查和治疗策略，似乎不足以实现世界卫生组织 (WHO) 设定的消除目标。

“即使在疫苗接种、筛查和治疗方面进行了广泛的综合推广，发病率和死亡率目标也可能无法实现，这凸显了重新评估全球 HBV 战略的必要性，以及开发针对 HBV 的治愈性疗法的重要性，并制定量身定制的策略来预防长期后遗症并改善移民的健康状况，”作者说。

开发了一个基于代理的模型来描述高收入国家的 HBV 流行情况，这些国家正在进行移民。通过性网络和围产期传播模拟了 HBV 传播。作者从文献中估计了模型参数，并根据历史 HBV 数据对其进行了校准。他们还进行了敏感性分析以评估不确定性。

根据目前的策略，作者预测，从 2015 年到 2030 年，急性乙型肝炎和由 HBV 引起的失代偿期肝硬化和肝细胞癌的发病率将分别下降 64.5%、9.4% 和 10.5%。慢性乙型肝炎的发病率然而，与肝脏相关的死亡风险将分别增加 26.6% 和 1.0%。

值得注意的是，这些发现对移民人数和移民中的 HBV 流行率很敏感。

“我们的分析表明，目前的疫苗接种、筛查和治疗策略不足以实现世卫组织消除慢性乙型肝炎的目标，”作者说。 “即使在疫苗接种、筛查和治疗方面进行了广泛的综合扩大，发病率和死亡率目标也可能无法实现。”
肝病杂志 2022;77:947-956

StephenW

HBV elimination goals set by WHO not attainable, experts say
Yesterday
HBV elimination goals set by WHO not attainable, experts say

Current efforts to eradicate hepatitis B virus (HBV), including vaccination, screening, and treatment strategies, do not seem enough to achieve the elimination goals set by the World Health Organization (WHO), suggests a recent study.

“Even with extensive integrated scale-up in vaccination, screening, and treatment, the morbidity and mortality targets may not be reachable, highlighting the need for a re-evaluation of the global strategy for HBV, the importance of developing curative therapy for HBV, and of establishing tailored strategies to prevent long-term sequelae and improve health in immigrants,” the authors said.

An agent-based model was developed to describe the HBV epidemic in a high-income country with ongoing immigration. HBV spread was simulated through sexual networks and perinatal transmission. The authors estimated model parameters from the literature and calibrated these against historical HBV data. They also carried out sensitivity analyses to evaluate the uncertainty.

Under the current strategies, the authors predicted that the incidence of acute hepatitis B and HBV-attributable decompensated cirrhosis and hepatocellular carcinoma would decrease by 64.5 percent, 9.4 percent, and 10.5 percent, respectively, between 2015 and 2030. The incidence of chronic hepatitis B and liver-related deaths, however, would risk by 26.6 percent and 1.0 percent, respectively.

Of note, these findings were sensitive to the number of immigrants and HBV prevalence in immigrants.

“Our analysis suggests that current vaccination, screening, and treatment strategies are inadequate to achieve the WHO goals of eliminating chronic hepatitis B,” the authors said. “Even with extensive integrated scale-up in vaccination, screening, and treatment, the morbidity and mortality targets may not be reachable.”
J Hepatol 2022;77:947-956