1. Achieving WHO Recommendations for HCV Elimination in the Western Pacific Region
L. Wei
April 13, 2016

2. In 2016, there are approximately 14 million viremic HCV infections in the Western Pacific region (0.7% prevalence)
Prevalence
(Viremic)
Total Infected
1,000,000
10,000,000
0.0%-0.6%
0.6%-0.8%
0.8%-1.3%
1.3%-2.9%
2.9%-12.0%
250,000
Source: Polaris Observatory (

3. In 2016, there are ~14M viremic infections, 3
In 2016, there are ~14M viremic infections, 3.6M already diagnosed, ~1M treated and 570K cured in the Western Pacific region
Median Age: 50-54
25%
The viremic prevalence of HCV in the WPRO region and Taiwan is 0.7% with one quarter of infections already diagnosed.
In 2016, an estimated 1.06 M patients (or 1% of total infected) are already treated.
Source: Polaris Observatory (

4. There is a wide range of prevalence, diagnosis rates and treatment rates across the Western Pacific region
Bubble Diameter: HCV Prevalence 4% 2% 1%
Source: Polaris Observatory (

5. Three countries account for 80% of viremic HCV infections, while China alone accounted for 80% of treated patients
Viremic HCV Infections (2016)
80% of Total
Number Treated & Treatment Rate
80% of Total
(Treatment Rate)
Source: Polaris Observatory (

6. Base 2014 Scenario – For comparison, the treatment paradigm in 2014 was extrapolated into the future
Continue to treat with Peg IFN based therapies
Treatment restricted to ≥F1
Screening is continued each year to find new HCV cases
2014
2016
2017
2020
2025
Treated
146,470
Newly Diagnosed
370,720
Fibrosis Stage
≥F1
New Infections
116,260
Treated Age
15-69
SVR (average)
63%
Source: Polaris Observatory (

7. HCV infections will decline by 30%, while liver related deaths (LRD), HCC & decompensated cirrhosis (DC) will increase by 25%

8. WHO Scenario – Increase screening, treatment and eligibility to achieve a 90% reduction in new infections
Switch to direct acting antivirals with higher SVR
Expand treatment to all patients (≥F0)
Expand screening to find infected individuals to treat and achieve 90% diagnosis rate
Increase treatment to achieve a 65% reduction in liver related deaths, 90% reduction in new infections
Starting in 2020, expand treatment up to 74 years of age
2014
2016
2017
2018
2020
2025
Treated
146,470
175,760
219,710
329,560
510,820
1,021,630
Newly Diagnosed
370,720
444,860
667,290
680,630
Fibrosis Stage
≥F1
≥F0
New Infections
117,530
116,260
81,380
48,830
24,410
10,990
Treated Age
15-69
15-74
SVR
63%
90%

9. HCV infections will decline 75% by 2030, while DC , HCC and LRD will decline 65% by 2030

10. The HBsAg+ prevalence in 2016 is estimated to be 6.7%
In 2016, there are an estimated 126 million HBsAg+ individuals in the Western Pacific region
HBsAg+
(Prevalence)
<1.0%
1.0%-2.5%
2.5%-5.0%
5.0%-10.0%
>10%
Total Infected
1 million
10 million
100 million .
The HBsAg+ prevalence in 2016 is estimated to be 6.7%
Source: Polaris Observatory (

11. Two countries accounted for over 80% of all hepatitis B infections in the Western Pacific region
HBsAg+ Individuals (2016)
80% of Total
Source: Polaris Observatory (

12. HBeAg: In 2016, it is estimated that 43% of HBsAg+ individuals in the Western Pacific region are HBeAg+
HBeAg+ Prevalence
(% of HBsAg+)
<2.5%
2.5%-5.0%
5.0%-10.0%
10.0%-20.0%
>20%
Source: Polaris Observatory (

13. HDV: In 2016, An estimated 3% of HBsAg+ individuals are anti-HDV+
Anti-HDV+ Prevalence
(% of HBsAg+)
<2.5%
2.5%-5.0%
5.0%-10.0%
10.0%-20.0%
>20%
Source: Polaris Observatory (

14. Conclusions:
There are an estimated 14 million viremic HCV and 126 million HBV infections in the region
Two countries (China and Viet Nam) in the region account for 80% of HBV infections
It is feasible to eliminate HCV infection in the Western Pacific region
Treatment must be increased six-fold by 2025 in order to achieve WHO recommendations
To reduce liver related deaths, eligibility has to increase to older patients – median age in this region is 50-54, and in 11 years half of the HCV infected population will be ineligible for treatment, unless age restrictions are expanded
Only moderate increases in screening are necessary to sustain treatment toward the WHO goal