1. 3rd International HIV/Viral Hepatitis Co-Infection Meeting HIV/Viral Hepatitis: Improving Diagnosis, Antiviral Therapy and Access Sunday, 17 July 2016 Durban, South Africa

2. Introduction Epidemiology of HIV, HBV & HCV infections
Global Burden of Viral hepatitis
WHO aims for eradication of viral hepatitis
Lancet. 2012;380 (9859):2095; BMC Medicine 2014;12:159; WHO; 2014 [EB 134/36]; Lancet 6 July 2016

3. Epidemiology: HIV, HBV & HCV infections
240 million persons are chronically infected with hepatitis B virus
million persons with hepatitis C
34 million persons with HIV
70% of global 34 million people with HIV live in sSA
Corresponding to regions of high HBV and HCV endemicity
HIV/HBV/HCV Mortality (annual death rate) ( in Nov 2012)
Majority of persons with chronic hepatitis B and hepatitis C
Unaware of their infection (95%)
Do not benefit from clinical care and treatment or interventions designed to reduce onward transmission (1% access Rx)
Liver-related mortality is twice as high for chronic hepatitis B co-infected as for chronic hepatitis C co-infected individuals. A CD4 count of <200 cells/mm3 is associated with a 16.2 fold increase in risk of liver-related death compared to a CD4 count of >350 cells/mm3 .
Clinical Infectious Diseases 2012; 55(4):507; J Clin Virol 2014;61:20

4. Global Burden of Disease
Global Burden of Disease study:
Viral hepatitis is responsible for approximately 1.45 million deaths/yr
HIV/AIDS: 1.3 million/yr
Malaria: 0.9 million/yr
Tuberculosis: 1.3 million/yr
Viral hepatitis is now the 7th leading cause of mortality worldwide
Mortality due to viral hepatitis has increased by 63% since 1990
Persistent lack of global awareness of the severity of the problem
Lack of commitment to combat and ultimately eliminate the disease
Lancet. 2012;380 (9859):2095; BMC Medicine 2014;12:159; WHO; 2014 [EB 134/36]; Lancet 6 July 2016

5. Global Burden of Viral Hepatitis 1990-2013
Viral hepatitis is a leading cause of death and disability worldwide
Globally, viral hepatitis deaths increased from 0·89 million (95% uncertainty interval [UI] 0·86–0·94) to 1·45 million (1·38–1·54)
YLDs from 0·65 million (0·45–0·89) to 0·87 million (0·61–1·18)
DALYs from 31·7 million (30·2–33·3) to 42·5 million (39·9–45·6)
Mortality and morbidity mainly due to hepatitis B and C infections
96% [95% UI 94–97] of mortality and 91% [88–93] of DALYs in 2013
Unlike most communicable diseases, the absolute burden and relative rank of viral hepatitis increased between 1990 and 2013
Lancet 6 July 2016

6. Global Burden of Viral Hepatitis 1990-2013
Burden of disease was not equally distributed worldwide
Hepatitis-related mortality highest (≥33.50 deaths per pop/year)
Oceania, western sub-Saharan Africa and central Asia
In absolute numbers, east Asia and south Asia
Greatest number of hepatitis deaths (52% of the total number of deaths)
Unlike HIV, which primarily occurs in low-income countries (mainly sSA)
58% hepatitis deaths occurred in upper-middle-income countries and
high-income countries
Lancet, 6 July 2016

7. Burden of Liver Disease
Liver disease due to chronic hepatitis B and C is a significant cause of morbidity and mortality in HIV infected individuals
Liver-related mortality 2x higher in HBV/HIV than in HCV/HIV co-infection
Without appropriate diagnosis and treatment
A third of those chronically infected with viral hepatitis will die as a result of complications of chronic liver disease: Cirrhosis, liver failure and HCC
Global antiretroviral therapy scale-up should limit HBV-related liver disease, through dual antiviral activity
HBV mono-infected individuals: frequently undiagnosed with limited access to therapy
New pangenotypic DAA regimens offer >90% cure to all HCV-infected individuals - short duration with minimal monitoring
Requires easy access to affordable diagnostics and generics
AIDS 2005;19(6):593; J Acquir Immune Defic Syndr 2000;24(3):211; J Inf Dis 2013;208(9):1454;
South Afr Med J 2012; 102:157; World J Hepatol 2010; 2: 65

8. WHO: Eradication of Viral Hepatitis
WHO aims by 2030
90% reduction in new cases of chronic hepatitis B and C
65% reduction in hepatitis B and C deaths
80% of treatment eligible persons with chronic hepatitis B and C infections treated
Globally, this will require
Development and Implementation of National Guidelines for the Prevention and Treatment of Viral Hepatitis
Development and Implementation of National Surveillance Strategies
Access to sustainable and affordable diagnostics and therapeutics
Enabling identification and linkage to care
Effective utilisation of existing infrastructures for delivery of care

9. Eradication of Viral Hepatitis
Ultimate elimination of HIV and viral hepatitis will require an effective partnership between:
Affected communities
Professional and community organisations
Governments and National Departments of Health
Researchers and health professionals
Pharmaceutical companies

10. Meeting Objectives
To review the latest therapeutic developments in viral hepatitis B and C
To identify challenges and successes in scaling up diagnosis, screening, antiviral treatment and prevention of viral hepatitis in HIV co-infected persons
To identify how to optimize outcomes and costs to achieve sustainable and equitable access to these therapies globally
To learn from successful models, such as novel voluntary licensing agreements and map a path toward scaling up of viral hepatitis treatment programmes in low-, middle- and high-income settings
To advance the agenda for viral hepatitis eradication by assembling key stakeholders for a face-to- face discussion of major barriers & solutions

11. Thanks for our sponsors and supporters