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The Hong Kong Association for the Study of Liver Diseases Across borders: The Hong Kong Association for the Study of Liver Diseases The challenge of HBV & HCV with increasing globalization The Hong Kong Association for the Study of Liver Diseases The Hong Kong Association for the Study of Liver Diseases The Hong Kong Association for the Study of Liver Diseases Prof CL Lai University of Hong Kong The Hong Kong Association for the Study of Liver Diseases Hong Kong The Hong Kong Association for the Study of Liver Diseases

The Hong Kong Association for the Study of Liver Diseases Disclosure The Hong Kong Association for the Study of Liver Diseases • I am personally responsible for this… The Hong Kong Association for the Study of Liver Diseases The Hong Kong Association for the Study of Liver Diseases The Hong Kong Association for the Study of Liver Diseases The Hong Kong Association for the Study of Liver Diseases The Hong Kong Association for the Study of Liver Diseases

The Hong Kong Association for the Study of Liver Diseases Overview The Hong Kong Association for the Study of Liver Diseases • Introduction: HBV & HCV • Global burden The Hong Kong Association for the Study of Liver Diseases • Effects of migration from high to low incidence countries • Effects of HBsAg escape mutants on vaccination The Hong Kong Association for the Study of Liver Diseases • Challenges to “elimination” of hepatitis by 2030 The Hong Kong Association for the Study of Liver Diseases The Hong Kong Association for the Study of Liver Diseases The Hong Kong Association for the Study of Liver Diseases

The Hong Kong Association for the Study of Liver Diseases Introduction: HBV & HCV The Hong Kong Association for the Study of Liver Diseases The Hong Kong Association for the Study of Liver Diseases The Hong Kong Association for the Study of Liver Diseases The Hong Kong Association for the Study of Liver Diseases The Hong Kong Association for the Study of Liver Diseases The Hong Kong Association for the Study of Liver Diseases

The Hong Kong Association for the Study of Liver Diseases Introduction: HBV & HCV The Hong Kong Association for the Study of Liver Diseases HCV • RNA virus The Hong Kong Association for the Study of Liver Diseases • Replication entirely cytoplasmic • Resides only in the liver The Hong Kong Association for the Study of Liver Diseases • Transmission: parental only, mainly through transfusion or intravenous drug use The Hong Kong Association for the Study of Liver Diseases • Most hepatocellular carcinoma (HCC) due to underlying cirrhosis The Hong Kong Association for the Study of Liver Diseases • >95% cure with 8 – 12 weeks of DAAs The Hong Kong Association for the Study of Liver Diseases

The Hong Kong Association for the Study of Liver Diseases Introduction: HBV & HCV The Hong Kong Association for the Study of Liver Diseases HBV The Hong Kong Association for the Study of Liver Diseases • Double-stranded DNA virus with integration into host DNA • Extra-hepatic pool, e.g. lymphocytes, testis The Hong Kong Association for the Study of Liver Diseases • Oncogenic virus (gene X, pre-S1,2); ~20% HCC non-cirrhotic • Transmission: parental only, mostly at birth or in early childhood, also unsafe sex The Hong Kong Association for the Study of Liver Diseases • Currently “functional” cure with loss of HBsAg only in ~10 %; the rest requires long-term treatment The Hong Kong Association for the Study of Liver Diseases The Hong Kong Association for the Study of Liver Diseases

The Hong Kong Association for the Study of Liver Diseases The Hong Kong Association for the Study of Liver Diseases HBV & HCV global burden/incidence The Hong Kong Association for the Study of Liver Diseases The Hong Kong Association for the Study of Liver Diseases The Hong Kong Association for the Study of Liver Diseases The Hong Kong Association for the Study of Liver Diseases The Hong Kong Association for the Study of Liver Diseases

The Hong Kong Association for the Study of Liver Diseases HBV vs HCV (2015) The Hong Kong Association for the Study of Liver Diseases HBV HCV The Hong Kong Association for the Study of Liver Diseases Global Incidence 257 million 71 million Highest: Middle East Distribution Highest: Africa, W Pacific The Hong Kong Association for the Study of Liver Diseases The Hong Kong Association for the Study of Liver Diseases The Hong Kong Association for the Study of Liver Diseases The Hong Kong Association for the Study of Liver Diseases WHO Global Hepatitis Report 2017.

The Hong Kong Association for the Study of Liver Diseases HBV: Incidence in children <5 years old The Hong Kong Association for the Study of Liver Diseases The Hong Kong Association for the Study of Liver Diseases The Hong Kong Association for the Study of Liver Diseases % HBsAg+ in The Hong Kong Association for the Study of Liver Diseases Children <5 yrs The Hong Kong Association for the Study of Liver Diseases The Hong Kong Association for the Study of Liver Diseases WHO Global Hepatitis Report 2017.

The Hong Kong Association for the Study of Liver Diseases HCV: Incidence The Hong Kong Association for the Study of Liver Diseases The Hong Kong Association for the Study of Liver Diseases The Hong Kong Association for the Study of Liver Diseases The Hong Kong Association for the Study of Liver Diseases Incidence/100,000 The Hong Kong Association for the Study of Liver Diseases The Hong Kong Association for the Study of Liver Diseases WHO Global Hepatitis Report 2017.

The Hong Kong Association for the Study of Liver Diseases HBV vs HCV (2015) The Hong Kong Association for the Study of Liver Diseases HBV HCV The Hong Kong Association for the Study of Liver Diseases Global incidence 257 million 71 million Distribution Highest: Africa, W Pacific Highest: Middle East The Hong Kong Association for the Study of Liver Diseases Chronicity >90% for children <2 55 – 85%* The Hong Kong Association for the Study of Liver Diseases The Hong Kong Association for the Study of Liver Diseases The Hong Kong Association for the Study of Liver Diseases * Rate lower with younger age WHO Global Hepatitis Report 2017.

The Hong Kong Association for the Study of Liver Diseases Question The Hong Kong Association for the Study of Liver Diseases With HBV infection, what is the chance of chronicity for adults The Hong Kong Association for the Study of Liver Diseases acquiring acute HBV infection? 1. 50-80% The Hong Kong Association for the Study of Liver Diseases 2. 10-20% The Hong Kong Association for the Study of Liver Diseases 3. <3% The Hong Kong Association for the Study of Liver Diseases The Hong Kong Association for the Study of Liver Diseases

The Hong Kong Association for the Study of Liver Diseases Infection acquired at adolescence and adulthood The Hong Kong Association for the Study of Liver Diseases Chronicity rate from different studies The Hong Kong Association for the Study of Liver Diseases • US veterans 0.26% (n = 579) 1 The Hong Kong Association for the Study of Liver Diseases • Greece 0% (n = 189) 2 • Greece 0.2% (n = 507) 3 The Hong Kong Association for the Study of Liver Diseases • Sweden 0% (n = 100) 4 The Hong Kong Association for the Study of Liver Diseases • Japan 1% (n = 301) 5 1 NEJM 1987; 316:965; 2 Infection 1985; 13:174; 3 Gastroenterology 1987; 92:1844; 4 Eur J Clin Microbiol Infection Dis 2000; 19:21; The Hong Kong Association for the Study of Liver Diseases 5 Hepatology 2006; 44:326.

The Hong Kong Association for the Study of Liver Diseases HBV vs HCV (2015) The Hong Kong Association for the Study of Liver Diseases HBV HCV The Hong Kong Association for the Study of Liver Diseases Global incidence 257 million 71 million Distribution Highest: Africa, W Pacific Highest: Middle East The Hong Kong Association for the Study of Liver Diseases Chronicity >90% for children<2 55 – 85%* 0 – 3% for adults The Hong Kong Association for the Study of Liver Diseases Co-infection with HIV ~2.7 million ~2.3 million New infections Declining because of Increasing because of The Hong Kong Association for the Study of Liver Diseases vaccination unsafe injections Current treatment Long-term/life-long 8 – 12 weeks only The Hong Kong Association for the Study of Liver Diseases * Rate lower with younger age WHO Global Hepatitis Report 2017.

The Hong Kong Association for the Study of Liver Diseases Hepatitis virus-related mortality data (2015) The Hong Kong Association for the Study of Liver Diseases Cause of death Deaths % Hepatitis Acute hepatitis B 87,076 0.2 The Hong Kong Association for the Study of Liver Diseases Acute hepatitis C 3,197 0.0 Acute hepatitis A or E 54,801 0.1 Sub-total viral hepatitis deaths 145,074 The Hong Kong Association for the Study of Liver Diseases The Hong Kong Association for the Study of Liver Diseases The Hong Kong Association for the Study of Liver Diseases The Hong Kong Association for the Study of Liver Diseases Global Health Estimates: 2000-2015. WHO 2016.