Reports Provide Guidance on HBV Testing, Address Challenges for HBV Response

Two recently published reports call attention to the importance of assessing patients for hepatitis B.

In a report published on HCVguidelines.org, officials with the Infectious Diseases Society of America and the American Association for the Study of Liver Diseases noted that physicians who are considering starting patients on treatment for hepatitis C should assess those same patients for hepatitis B, as reactivation has been reported during or after direct acting antiviral therapy. ¹

In a separate report published in The Lancet Infectious Diseases²  researchers called for a scale-up of both prevention and treatment interventions  to reduce the global prevalence of hepatitis B virus.  

Composed of age, sex, and 21 Global Burden of Disease world regions, the researchers in the Lancet Infectious Diseases study constructed a “dynamic, deterministic mathematical transmission model of the global hepatitis B epidemic.” 

The model, which the researchers noted was limited by scarcity of data in certain regions of the world as well as limited vaccination data,  suggested that maintaining the status quo will lead to 17 million avoidable deaths over the next 15 years. However, scaling-up “prevention and treatment could lead to a 90% reduction in incidence of new chronic infections and 65% reduction in worldwide mortality by 2030.” 

The global cost of scaling-up prevention and treatment would peak at $7.5 billion annually averaging $5.5 billion per year between 2015 and 2030, smaller than the $8.1 billion per year forecasted for HIV funding, according to the study researchers.

The researchers listed 3 main challenges that need to be addressed including:

• Reducing mother-to-child transmission, which the researchers noted presents a major operational challenge, especially in sub-Saharan Africa and southeast Asia
• Increasing programs that can help identify cases and delivery of antiviral therapy
• Developing a cure for HBV infection, which could reduce projected costs

Substantial new innovations are needed to eliminate HBV, in addition to vaccination efforts. The IDSA/AASLD guidance also called attention to the importance of prevention, recommending HBV vaccination for all susceptible individuals.

References

1.      People with hepatitis C should be tested for hepatitis B before starting antiviral therapies [news release]. Alexandria, Virginia. American Association for the Study of Liver Diseases. September 16, 2016.

2.      Nayagam S, Thursz M, Sicuri E, et al. Requirements for global elimination of hepatitis B: a modelling study. Lancet Infect Dis. 2016; pii: S1473-3099(16)30204-3. doi: 10.1016/S1473-3099(16)30204-3.