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Screening for hepatitis D and PEG-Interferon over Tenofovir enhance general hepatitis control efforts in Brazil

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  • Ashish Goyal
  • Ethan Obie Romero-Severson

Abstract

Background: Hepatitis D virus (HDV), which requires the presence of hepatitis B virus (HBV), is a deadly yet neglected disease that rapidly leads to liver cancer and disease-induced mortality. This co-dependence creates complex transmission dynamics that make it difficult to predict the efficacy of interventions aimed at HBV and/or HDV control in endemic regions, such as certain municipalities of Brazil, where up to 65% of HBV-infected persons are co-infected. Methodology: We created a mathematical model that captures the joint transmission dynamics of HBV and HDV, incorporating mother-to-child, sexual and household transmission. With an aim to minimize the number of total infections and disease-induced mortality in 2027, we then determined optimal strategies for Brazil and its sub-regions under a constrained budget, which was dynamically allocated among HBV and HDV screening, HBV and HDV treatment, HBV newborn and adult vaccination, and awareness programs. Three treatment options were considered, namely: Tenofovir, PEGylated-Interferon, and nucleic acid polymers (NAP). Results: The additional cost of HDV screening and the use of a more expensive PEGylated-Interferon are offset by not wasting resources on treating co-infected persons with Tenofovir. The introductory price of NAP treatment must be less than $16,000 per course to become competitive with Tenofovir and PEGylated-Interferon in Brazil. Conclusion: Additional screening for HDV is beneficial, even in a low HBV and HDV endemic regions of Brazil. We recommend PEGylated-Interferon, wherever possible, for both HBV and HDV. If PEGylated-Interferon is not available in abundance, PEGylated-Interferon for co-infections and 4-year Tenofovir treatment for mono-infections is recommended.

Suggested Citation

  • Ashish Goyal & Ethan Obie Romero-Severson, 2018. "Screening for hepatitis D and PEG-Interferon over Tenofovir enhance general hepatitis control efforts in Brazil," PLOS ONE, Public Library of Science, vol. 13(9), pages 1-17, September.
  • Handle: RePEc:plo:pone00:0203831
    DOI: 10.1371/journal.pone.0203831
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    References listed on IDEAS

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    1. Goyal, Ashish & Murray, John M., 2016. "Recognizing the impact of endemic hepatitis D virus on hepatitis B virus eradication," Theoretical Population Biology, Elsevier, vol. 112(C), pages 60-69.
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