Canadian Association for the Study of the Liver Single Topic Conference on Hepatitis B Virus: 'Progress toward hepatitis B elimination in Canada'

Abstract

Hepatitis B virus (HBV) infection affects >290 million people worldwide, including ∼250,000 Canadians, and it stands as a leading cause of end-stage liver disease and liver cancer. The World Health Assembly has set goals for HBV elimination by 2030, aiming for a >90% reduction in incidence and a 65% reduction in deaths compared to 2015. However, as of 2023, no countries were on track to achieve these targets. In Canada, challenges in HBV elimination persist due to the lack of a universal birth dose vaccine and interprovincial disparities in screening and care linkage. The Canadian Association for the Study of the Liver (CASL) and the Canadian Hepatitis B Network hosted the Inaugural Progress toward Hepatitis B Elimination Meeting in Calgary, Alberta, Canada (September 29, 2023 to October 1, 2023). This collaborative platform brought together national and international clinicians, laboratory providers, public health researchers, policymakers, and community-based organizations interested in HBV and hepatitis Delta virus (HDV) / HBV coinfection. The workshop was held during the National Day of Truth and Reconciliation (September 30, 2023) to commemorate the tragic legacy of residential schools in Canada, and it highlighted the need to promote meaningful reconciliation with Indigenous peoples. Key outcomes of the summit included establishing objectives for HBV elimination, advocating for adherence to global targets, universal screening and birth dose vaccination, equitable access to antiviral treatment across all provinces/territories, and addressing special populations. This overview highlights the presentations and emphasizes the importance of collaboration among stakeholders, public health agencies, and government entities to strive for HBV elimination in Canada.

Keywords: CanHepB; clinical; epidemiological; hepatitis B virus; hepatitis D virus; public health.

Figure 1:. Rates of reported chronic and unspecified hepatitis B cases per 100,000 population by province and territory (Figure reproduced from “Hepatitis B in Canada: 2021 surveillances data”)

Figure 2:. Rates of chronic and unspecified hepatitis B overall and by sex in Canada, 2012 to 2021

Figure 3:. Management of CHB in pregnancy to prevent infant immunoprophylaxis failure (WHO 2020)

Figure 4:. HBV-associated hepatocarcinogenesis

Figure 5:. Expanded approach for treating patients with chronic hepatitis B (presented by Dr. N Terrault)

Figure 6:. The mechanism of action for compounds under investigation for hepatitis B treatment

Figure 7:. An overview of classic and new/emerging biomarkers to guide management and assessing novel therapies aimed at achieving an HBV cure