1. Hepatitis and Liver Diseases
October 10-12, 2016 Dubai, UAE
3rd World Congress on
Hepatitis and Liver Diseases
Hepatitis C Virus (HCV) infection:
a global epidemiological up-date
of the circulation of HCV genotypes
World J. Gastroenterol ; 22(34):
Dr. Arnolfo Petruzziello, PhD
Unit of Virology and Molecular Biology
IRCCS- Fondazione G. Pascale - Naples, Italy
A. Petruzziello: HCV infection: a global epidemiology up date

2. Hepatitis C virus
one of the major globally health burden and causes of death and morbidity;
recent estimates showed an increase in its prevalence over the last decade to 2.8% (>185 million infections worldwide).
A. Petruzziello: HCV infection: a global epidemiology up date

3. Hcv to Hcc pyramid
A. Petruzziello: HCV infection: a global epidemiology up date

4. Total predicted deaths HCV-related 2005-2030
if 15% of HCV chronic patients will receive anti-HCV treatment with 80% of sustained viral response (SVR);
if 50% of HCV chronic patients will receive anti-HCV treatment with 60% of SVR;
if 50% of HCV chronic patients will receive anti-HCV treatment with 80% of SVR ;
if all HCV chronic patients will receive anti-HCV treatment with 60% of SVR.
S. Deuffic-Burban: Estimating the Future Health Burden of Chronic Hepatitis C and Human Immunodeficiency Virus Infections in the United States. J Viral Hepat. 2007;14(2):  
A. Petruzziello: HCV infection: a global epidemiology up date

5. The HCV epidemiological paradigm varies regionally depending on its historical and present risk factors.
A country-specific policy of prevention, diagnosis and treatment could surely reduce this disease burden
A. Petruzziello: HCV infection: a global epidemiology up date

6. Prevalence of Chronic HCV infection
Mohd Hanafiah K, Groeger J, Flaxman AD, Wiersma ST. Global epidemiology of hepatitis C virus infection: new estimates of age-specific antibody to HCV seroprevalence. Hepatology 2013; 57:
A. Petruzziello: HCV infection: a global epidemiology up date

7. Although antibodies to HCV (anti-HCV) are at present the most commonly available marker of HCV infection,
the most important indicator of HCV diffusion seems to be its classification into its different genetic variants.
A. Petruzziello: HCV infection: a global epidemiology up date

8. The length of the therapy and the opportunity to associate interferon and/or ribavirin with the new direct-acting antiviral (DAA) therapies still remain partially dependent on HCV genotype.
A. Petruzziello: HCV infection: a global epidemiology up date

9. Unfortunately, however, in many countries there is a lack of robust epidemiological data with no attention to HCV genotypes distribution.
A. Petruzziello: HCV infection: a global epidemiology up date

10. HCV genotypes
HCV is classified into seven recognized genotypes on the basis of sequence of the viral genome, each differing at % of nucleotide sites and into 67 confirmed and 20 provisional subtypes, differing at < 15% of nucleotide sites .
A. Petruzziello: HCV infection: a global epidemiology up date

11. HCV genotyping assays polymorphisms Kinetic amplification
RFLP restriction fragment length
polymorphisms
Kinetic amplification
Line probe assays (LiPA)
A. Petruzziello: HCV infection: a global epidemiology up date

12. HCV genotypes distribution
Epidemic subtypes (1a, 1b, 2a, and 3a) are widely distributed worldwide and account for a great proportion of the totality of HCV cases, especially in high income countries;
Endemic subtypes (4, 5a, 6a) are comparatively more rare and have been restricted for long time in specific regions, as West Africa, Southern Asia, Central Africa and South Eastern Asia .
A. Petruzziello: HCV infection: a global epidemiology up date

13. Worlwide geographic distribution of HCV genotypes
Messina JP, Humphreys I, Flaxman A, Brown A, Cooke GS, Pybus OG, Barnes E. Global distribution of Hepatitis C virus Genotypes. Hepatology 2015; 61 (1):77-87.
A. Petruzziello: HCV infection: a global epidemiology up date

14. the viraemic rate (HCV- RNA positive) genotype distribution
The purpose of this study was to conduct a comprehensive review of recently published literature to estimate :
anti- HCV prevalence
the viraemic rate (HCV- RNA positive)
genotype distribution
A. Petruzziello: HCV infection: a global epidemiology up date

15. METHODS
The average HCV prevalence, viraemic rate and genotype distribution for each continent was calculated by dividing the sum of data reported from each region to the total number of countries within the region.
A. Petruzziello: HCV infection: a global epidemiology up date

16. Regions included in the analysis were those defined by the Global Burden of Diseases, Injuries, and Risk Factors 2010 (GBD) study, defined as … ‘‘epidemiologically homogenous as possible so that information from detailed studies in one country can plausibly be extrapolated to other countries in the region to create burden estimates that are useful to individual countries in planning for health sector activities”
A. Petruzziello: HCV infection: a global epidemiology up date

17. GBD Regions Africa: Asia: North Africa and Middle East Australasia
Central Sub- Saharan Africa
Central Asia
East Sub- Saharan Africa
East Asia
Southern Sub- Saharan Africa
Pacific Asia, High- Income
West Sub- Saharan Africa
South Asia
Southeast Asia
North Africa
and Middle East
Australasia
Americas:
Europe:
North America
Central Europe
Caribbean
Eastern Europe
Andean Latin America
Western Europe
Central Latin America
Southern Latin America
Tropical Latin America
A. Petruzziello: HCV infection: a global epidemiology up date

18. Inclusion Criteria Total of 557 articles
Date of publication ( );
Sources: Pub Med and official databases;
Language (only English);
Impact factor (> 1.5);
Adult populations;
Sample size (> 500);
Anti-HCV assay (3rd generation test);
Well described PCR RT system;
Genotyping (LiPa assay);
General population (no blood donors or high risk groups)
A. Petruzziello: HCV infection: a global epidemiology up date

19. Exclusion criteria
Countries for which we were unable to obtain HCV genotype prevalence data were excluded from calculations of regional proportions, although their populations were included in the total population size of each region when generating regional genotype prevalence estimates.
A. Petruzziello: HCV infection: a global epidemiology up date

20. 138 studied countries over 90% global population
28.3%
26.1%
1.4%
13.8%
18.8%
11.6%
A. Petruzziello: HCV infection: a global epidemiology up date

21. Results
Studying 138 countries worldwide total global HCV prevalence is estimated at 2.5% (177 million of HCV infected adults).
A. Petruzziello: HCV infection: a global epidemiology up date

22. Global Anti-HCV prevalence
2.9 %
2.7
1.8
1.8
1.3
A. Petruzziello: HCV infection: a global epidemiology up date

23. Regional Anti-HCV prevalence (%)
Sub Saharan Africa
Americas
Asia
Europe
A. Petruzziello: HCV infection: a global epidemiology up date

24. Results
The global average viraemic rate is at 67% (118.9 million of HCV RNA positive cases)
A. Petruzziello: HCV infection: a global epidemiology up date

25. Global Anti-HCV viraemic rate.
74.8
70.5
74.0
72.4 %
68.8
64.4
A. Petruzziello: HCV infection: a global epidemiology up date

26. Regional Anti-HCV viraemic rate.
Sub Saharan Africa
Americas
Asia
Europe
A. Petruzziello: HCV infection: a global epidemiology up date

27. Global HCV genotype distribution (%)
2.0
1.8
1.4
16.8
49.1
17.9
11.0
A. Petruzziello: HCV infection: a global epidemiology up date

28. Regional HCV genotype distribution (%)
A. Petruzziello: HCV infection: a global epidemiology up date

29. Sub Saharan Africa Anti-HCV prevalence: 2.9%
Anti-HCV infected (million): 26,9
Anti-HCV viraemic rate: 70.5%
Viraemic infected (million): 19,0
Central
West
East
Southern
A. Petruzziello: HCV infection: a global epidemiology up date

30. Anti-HCV prevalence in Sub Saharan Africa (%)
6.0
2.4
2.4
0.9
A. Petruzziello: HCV infection: a global epidemiology up date

31. Anti-HCV prevalence in Sub-Saharan Africa
A. Petruzziello: HCV infection: a global epidemiology up date

32. HCV genotype distribution in Sub Saharan Africa(%)
3.4
12.2
26.3
28.1
23.7
6.3
A. Petruzziello: HCV infection: a global epidemiology up date

33. HCV genotype distribution in Sub Saharan Africa%
A. Petruzziello: HCV infection: a global epidemiology up date

34. HCV genotype distribution in Sub-Saharan Africa.
A. Petruzziello: HCV infection: a global epidemiology up date

35. North Africa/Middle Eastern Area
Anti-HCV prevalence: 2.7%
Anti-HCV infected (million): 12.7
Anti-HCV viraemic rate: 68.8%
Viraemic infected (million): 8.7
A. Petruzziello: HCV infection: a global epidemiology up date

36. Anti-HCV prevalence in North Africa/Middle Eastern Area (%)
A. Petruzziello: HCV infection: a global epidemiology up date

37. HCV genotype distribution in North Africa/Middle Eastern Area(%)
0,3
27,3
0,8
65,3
6,3
A. Petruzziello: HCV infection: a global epidemiology up date

38. HCV genotype distribution in North Africa/Middle Eastern Area.
A. Petruzziello: HCV infection: a global epidemiology up date

39. The Americas Anti-HCV prevalence: 1.3%
Anti-HCV infected (million): 12.74
Anti-HCV viraemic rate: 74.0%
Viraemic infected (million): 9.2
North
Caribbean
Andean Latin
Andean Central
Southern Latin
Tropical Latin
A. Petruzziello: HCV infection: a global epidemiology up date

40. Anti-HCV prevalence in The Americas (%)
1.6
1.5
1.5
1.4
1.2
1.2
A. Petruzziello: HCV infection: a global epidemiology up date

41. Anti-HCV prevalence in The Americas.
A. Petruzziello: HCV infection: a global epidemiology up date

42. HCV genotype distribution in The Americas (%)
0,3
2.6
1.7
10.6
10.2
74.5
A. Petruzziello: HCV infection: a global epidemiology up date

43. Regional HCV genotype distribution
in The Americas (%) %

44. HCV genotype distribution in The Americas
country by country.
A. Petruzziello: HCV infection: a global epidemiology up date

45. Asia Anti-HCV prevalence: 2.8% Anti-HCV infected (million): 111.6
Anti-HCV viraemic rate: 64.4%
Viraemic infected (million): 71.9
Central
East
South
Southeast
Pacific
A. Petruzziello: HCV infection: a global epidemiology up date

46. Anti-HCV prevalence in Asia (%)
5.8 %
2.8
2.5
1.6
1.1
A. Petruzziello: HCV infection: a global epidemiology up date

47. Anti-HCV prevalence in Asia.
A. Petruzziello: HCV infection: a global epidemiology up date

48. HCV genotype distribution in Asia (%)
4.3
7.0
1.0
22.4
46.6
18.6
A. Petruzziello: HCV infection: a global epidemiology up date

49. HCV genotype distribution in Asia%
A. Petruzziello: HCV infection: a global epidemiology up date

50. HCV genotype distribution country by country
in Asia.
A. Petruzziello: HCV infection: a global epidemiology up date

51. Australasia Anti-HCV prevalence: 1.8% Anti-HCV infected (million): 0.5
Anti-HCV viraemic rate: 74.8%
Viraemic infected (million): 0.4
A. Petruzziello: HCV infection: a global epidemiology up date

52. Anti-HCV prevalence in Australasia.
A. Petruzziello: HCV infection: a global epidemiology up date

53. HCV genotype distribution in Australasia.
A. Petruzziello: HCV infection: a global epidemiology up date

54. Europe Anti-HCV prevalence: 1.8% Anti-HCV infected (million): 13.4
Anti-HCV viraemic rate: 72.4%
Viraemic infected (million): 9.7
Central
Western
Eastern
A. Petruzziello: HCV infection: a global epidemiology up date

55. Anti-HCV prevalence in Europe (%)
3.1
1.3
0.9
A. Petruzziello: HCV infection: a global epidemiology up date

56. Anti-HCV prevalence in Europe.
A. Petruzziello: HCV infection: a global epidemiology up date

57. HCV genotype distribution in Europe (%)
0,7
3.7
25.5
64.4
5.5
A. Petruzziello: HCV infection: a global epidemiology up date

58. Regional HCV genotype distribution in Europe%
A. Petruzziello: HCV infection: a global epidemiology up date

59. HCV genotype distribution in Europe.
A. Petruzziello: HCV infection: a global epidemiology up date

60. Conclusions
If compared to a similar study concerning the period , the prevalence and the number of HCV infected patients has decreased from 2.8% to 2.5% and from 185 to 177 million.
The most relevant decrease is observed in the high income zones, especially Western Europe (-1.5%),
Southern Africa (-1.2%) and Australasia (- 0.9%), whereas a massive increase it’s reported in the low income areas as Central Africa (+3.7%) and Central Asia (+2.0%).
A. Petruzziello: HCV infection: a global epidemiology up date

61. However, significant regional, country and local variations exists…
Conclusions
Globally, genotype 1 is the most common HCV genotype (49.1%) , followed by genotype 3 (17.9%).
However, significant regional, country and local variations exists…
A. Petruzziello: HCV infection: a global epidemiology up date

62. Conclusions
Although HCV genotypes 1 and 3 are the most prevalent globally (67.0% if considered together), other genotypes are particularly common in lower-income countries, as G2 in West Africa and South America and G4 and G6, respectively in Central and Northern Africa and in Southeast Asia.
G2, G4, and G6 combined account for nearly one third of all HCV cases globally.
A. Petruzziello: HCV infection: a global epidemiology up date

63. Limits of the study
The lack of information available from some extended regions;
lack of robust epidemiology studies
at national level;
High percentage of randomized studies.
A. Petruzziello: HCV infection: a global epidemiology up date

64. Take Home Message
Globally anti- HCV prevalence have decreased from 2005 to date, probably for the impact of the new DAA therapies.
This finding suggests that a better knowledge of genotype distribution, especially in its subtype diversification, may be critic for the complete understanding of HCV disease and its eradication.

65. Samantha Marigliano and Giovanna Loquercio
A special thanks to
Samantha Marigliano and Giovanna Loquercio
for their great support in the realization
of this study
A. Petruzziello: HCV infection: a global epidemiology up date

66. Thank you for your attention
Unit of Virology and Molecular Biology “V. Tridente”
IRCCS Fondazione G. Pascale - Naples (Italy)