By Stan Deresinski, MD, FACP, FIDSA
Clinical Professor of Medicine, Stanford University
Dr. Deresinski reports no financial relationships relevant to this field of study.
SYNOPSIS: Only 1.5% of all individuals in the world with chronic hepatitis B virus infection are receiving treatment.
SOURCE: Hutin Y, Nasrullah M, Easterbrook P, et al. Access to treatment for hepatitis B virus infection — worldwide, 2016. MMWR Morb Mortal Wkly Rep 2018;67:773-777.
In 2016, the World Health Assembly endorsed World Health Organization (WHO) goals for the elimination of hepatitis B virus (HBV) and hepatitis C virus infections by 2030. More specifically, the global goal is a 90% reduction in the incidence and a 65% reduction in mortality. Of the estimated 257 million HBV-infected individuals in 2016, only approximately 27 million (10.5%) had been diagnosed and were aware that they were infected. Furthermore, only 4.5 million (16.7%; 1.5% of all infected individuals) of these were receiving antiviral therapy. The proportion of infected individuals was low across countries’ income strata, but, interestingly was highest in upper-middle-income countries (see Figure), not in high-income countries. As expected, low-income countries performed the worst.
Approximately 3.5% of the world’s population in 2017 was chronically infected with HBV and almost 900,000 died, mostly from cirrhosis and/or hepatocellular carcinoma. Unfortunately, only approximately 4.5 million (1.8%) of all individuals with HBV in the world were receiving therapy directed against this viral infection.
A prime example of the failure to deal with the problem is exemplified by Africa, which has among the highest rates of chronic HBV infection and the highest mortality from related hepatocellular carcinoma in the world. Despite this, there are no national programs in the entire region, with limited exceptions, such as pilot programs and those associated with HIV activities, that provide testing and treatment services.
The failure to address global HBV infection exists even though the WHO-recommended anti-HBV drugs tenofovir and entecavir are available in most or all countries of the world and that their cost has decreased. Thus, in 2015, the yearly cost of entecavir was as low as $427, while that of WHO-prequalified generic tenofovir in 2016 was only $32.
This dramatic decrease in cost should provide low- and middle-income countries an opportunity for dealing with the problem of chronic HBV infection. This will require the development of national strategies with initial prioritizing of treatment initiation to individuals who have developed cirrhosis already, followed by more expansive use.