C

HBV:
2 . - HBV

~ 350 .
HCC
30% - 50% HCC HBV



HBV 50-100
HIV

HBV -
> 14 (~ 1 / 20)

73,000

2,000,000

5000

3100

230

OLTX/

 -
~ 2 million people have chronic hepatitis B
400,000-600,000 diagnosed
200,000-300,000
entered into care
< 50,000 are
receiving antiviral
treatment

Cohen C, et al. J Viral Hepat. 2011;18:377-383.

V-
Liver Cancer
(HCC)

30%

HBV
Acute
Infection

Chronic
Infection

Cirrhosis

Liver
Transplantation

Death

> 90%
< 5%

Liver Failure
(Decompensation)

23% 5

6 LTx

HBV
IVDU
STD

HIV/HCV

HBsAg (+)

Weinbaum CM, et al. MMWR Recomm Rep. 2008;57(RR-8):1-20.

Lok AS, et al. Hepatology. 2009;50:661-662.

HBV

 HBV

 HBV

HBsAg

High prevalence
areas (45%)

,
, ,

>8%

70-90%

Intermediate
prevalence areas
(43%)

,

2-7%

20-60%

Low prevalence
areas (12%)
,
,

<2%

<20%



14

Universal infant
vaccination

12
10

Incidence*

8
6

Universal vaccination
of infants
recommended in 1991
80% decline in
incidence

4
2
0
1982 1984 1986 1988 1990 1992 1994 1996 1998 2000 2002 2004 2006

Yr
*Per 100,000 population.
Wasley A, et al. MMWR Surveill Summ. 2008;57(SS-2):1-24.



Incidence

1.0

0.6
0.4

1.0

0.70
0.57

0.36

0.2

Per 100,000 Children

(6-14 Yrs)

Per 100,000 Children

(6-14 Yrs)

0.8

Mortality

0.8
0.6

0.80

0.58

0.4

0.34

0.2
0

1981-86 1986-90 1990-94

Time Period
*Nationwide vaccination in Taiwan, implemented July 1984.
Chang MH, et al. N Engl J Med. 1997;336:1855-1859.

1981-86 1986-90 1990-94

Time Period


HBV
A, B, C, B, C
D, G

A
D

A, D, E
A, B,
C, D

Liaw YF, et al. Liver Int. 2005;25:472-489. Chu CJ, et al. Gastroenterology. 2003;125:444-451.



HBV

(1998)



HBsAg

3-5% 24.5%
3.3% - 7.2%


(50-80%) HBV
70

HBsAg
, 4% 1973 0.32% 2005


HBsAg
:
8.2%
4.3%
3.4%

Zacharakis et al, Euro Surveill 2009




HBsAg (+) 22.6%
Dalekos et al, Eur J Gastroenterol hepatol 1995

13581
HBsAg (+) 0.29%
, 5.1% 4.2 %
.
Elefsiniotis et al, J Clin Virol 2005


70 - HBsAg(+) -2.4%
4.6%
400
HBsAg (+) 1.25% HBV 16%.

Antypa et al, J Chemotherapy,2005

PNET-GREECE

(1997-2006) 3480
(20 )

PNET-GREECE

HEPNET-GREECE

Raptopoulou et al, J of Viral Hepatitis, 2008

HEPNET-GREECE

Raptopoulou et al, J of Viral Hepatitis, 2008

HBV


2004 - 2007
100 - 63 HBV

(57 6 , 64,42 )



CAUSE -HCC GROUP
10%
11%

16%

63%

HBV
HCV
ALCOHOL
OTHER

BV OLTx


140-170 HCV
3-4
3.9 HCV
~ 12,000
~ 7.3-8.8 HCV
22
86,000 2002

 HCV

Europe
8.9 million
(1.03%)

Western Pacific
62.2 million
(3.9%)

Americas
13.1 million
(1.7%)
Africa
31.9 million
(5.3%)

Eastern
Mediterranean
21.3 million
(4.6%)

Southeast Asia
32.3 million
(2.15%)

 HCV
200
HCV RNA

+/-

ALT (IU/l)

150

+ Resolution

100

Chronic
50
0
0

12

Month
Illustration by Mitchell L. Shiffman, MD.

18

24

 HCV

Acute HCV
Resolved
15% (15%)

Chronic HCV
85% (85%)

Stable
80% (68%)

HCC, hepatocellular carcinoma

Cirrhosis
20% (17%)

Slowly
progressive
75% (13%)

HCC
Liver failure
25% (4%)

 HCV
485 HCV 70 (followup: 31 )
1.0
First liver transplant:
18 yrs after infection
Survival Probability

0.8

First death: 28 yrs

after infection

0.6
0.4
0.2
0
0

Overall survival
Liver transplantation-free
survival
5 10 15 20 25 30 35 40 45
Survival Time Since Infection (Yrs)

Reprinted from J Hepatol, v47, Ferenci P, Ferenci S, Datz C, Rezman I, Oberaigner W, Strauss R, Morbidity and
mortality in paid Austrian plasma donors infected with hepatitis C at plasma donation in the 1970s, pp31-36.
Copyright 2007, with permission from Elsevier.

 HCV
C
10% -20% 10-20
1% - 5% HCV HCC
25% ~ 500,000 HCC
HCV

HCV
10
/ HCV

1. Lavanchy D. Clin Microbiol Infect. 2011;17:107-115. 2. Montalto G, et al. Ann N Y Acad Sci.
2002;963:
13-20. 3. Milliman, Inc. Consequences of HCV: costs of a baby boomer epidemic, 2009. 4. Jacobson
IM,
et al. Clin Gastroenterol Hepatol. 2010;8:1017-1029.

Anti-HCV Positive (%)

3.0

1.0
0

< 11

Alter MJ, et al. N Eng J Med. 1999;341:556-562.

20-29

40-49

60-69

 HCV IVDU
Amsterdam[1]

74

Bulgaria[2]

74
67

Moscow[3]

87

New Zealand[4]

88

Baltimore[5]
63

New York[6]
0

20

40

60

HCV Prevalence (%)

80

100

HCV

87

Hemophilia
Injecting Drug Users

79

Hemodialysis

10

STD Clients

General Population Adults

3.5

Surgeons

Pregnant Women

Military Personnel

0.3
0

10

20

30

40

50

60

70

80

Average Proportion Anti-HCV Positive (%)

Centers for Disease Control and Prevention, 2003.

90

100


HCV
10 776 anti-HCV (-)
HCV
: 1.8/wk

3 ( 0.37/1000 pt-yrs),

Vandelli C, et al. Am J Gastroenterol. 2004;99:855-859

50% HCV

: 44%
. : 69%
: 84%
: 90%
: 98%

1. Gordon FD. Am J Med. 1999;107:36S-40S. 2. Culver DH, et al. Transfusion. 2000;40:1176-1181.

3. Eurasian Harm Reduction Network. Comparative analysis of HCV prevalence across selected
countries of Europe and the Mediterranean area. October 2007.

HCV

Ghany MG, et al. Hepatology. 2009;49:1335-1374.



1992
IVDU

HCV+

Body piercing - tattoo


HCV
IVDU
HCV
HIV


AST,ALT
1992
anti-HCV +

HCV
HCV

 HCV ()
Type 2
17%

Type 1
72%

McHutchinson JG, et al. N Engl J Med. 1998;339:1485-1492.

Type 3
10%
All others
1%

 -
1080 ,
(86%)

Giannousis et al, Eur J Gastroenterol Hepatol, 2010

HEPNET-GREECE

(1997-2006) 2817
C 20

HEPNET-GREECE

HEPNET-GREECE

HEPNET-GREECE

Raptopoulou et al, Hippokratia, 2011

HEPNET-GREECE

Raptopoulou et al, Hippokratia,

2011

HEPNET-GREECE

Raptopoulou et al, Hippokratia, 2011

HEPNET-GREECE

Raptopoulou et al, Hippokratia, 2011