Updated HCV Global Burden Estimates S. Blach April 13, 2016

HCV Disease Burden Models Methodology HCV Disease Burden Models Reviewed all published work to estimate HCV prevalence and genotype distribution in all countries Models have been developed for 160 countries, covering 99.7% of the world’s total population Country Verified – Modeled HCV disease burden and intervention strategies to minimize future morbidity and mortality in 60 countries in collaboration with local experts & MoH and are in discussions with another 7 countries Polaris Estimate – Modeled HCV disease burden and WHO recommended strategies in 35 countries using published data Extrapolated Estimates – When no reliable data were available, modeled HCV disease burden for 58 countries using other countries as analogues or regional estimates Country verified and Polaris estimates have been uploaded to Polaris Observatory website (http://polarisobservatory.com) We classify the models into three categories

Country verified disease burden models capture more than 50% of the global prevalence of HCV Extrapolated prevalence estimates account for only 12% of total viremic infections

HCV burden was verified in 60 countries, discussions are underway in 7 countries and 35 others were modeled using published data Countries with HCV Epidemiology Data Prevalence (Viremic) 0.0%-0.6% 0.6%-0.8% 0.8%-1.3% 1.3%-2.9% 2.9%-6.7% Grey countries do not have reliable estimates Source: Polaris Observatory (http://www.polarisobservatory.com/)

In 2015, 500K patients were treated and cured with DAAs. An estimated 70 million (56 million – 90 million) individuals are infected with HCV (viremic), a prevalence of 1% (0.8%-1.2%) in 2016 Prevalence (Viremic) Total Infected 3,000,000 6,000,000 0.0%-0.6% 0.6%-0.8% 0.8%-1.3% 1.3%-2.9% 2.9%-6.7% 250,000 Income doesn’t match up with map In 2015, 500K patients were treated and cured with DAAs. Source: Polaris Observatory (http://www.polarisobservatory.com/)

Updated published estimates, an aging population and a focus on viremic infections contribute to a lower estimated viremic prevalence Loss due to more recent estimates for India and China, and the impact of time (mortality) Viremic Rate of 70% Updated estimate for Nigeria, impact of time, 500k cured patients in 2015 On this slide we would like to show how global prevalence estimates have changed over time In the present analysis, all available data were adjusted for viremia, and the populations were aged to 2016 to account for mortality Sources: Mohd Hanafiah K, Groeger J, Flaxman AD, Wiersma ST. Global epidemiology of hepatitis C virus infection: New estimates of age-specific antibody to HCV seroprevalence. Hepatology 2013; 57(4): 1333-42. - Gower E, Estes C, Blach S, Razavi-Shearer K, Razavi H. Global epidemiology and genotype distribution of the hepatitis C virus infection. Journal of Hepatology 2014; 61(1S): S45-S57.

30 countries account for 80% of viremic infections, while 7 countries account for 80% of treated patients Viremic HCV Infections (2016) 50% of Total 80% of Total Number Treated (2015) 80% of Total 30 = 12% Source: Polaris Observatory (http://www.polarisobservatory.com/)

Conclusions The present analysis reports a 2016 viremic prevalence estimate of 70 million (56 million – 90 million) viremic infections, using a disease burden modeling approach and accounting for mortality and cure A small number of countries (30) account for over 80% of the global HCV burden Country verified disease burden models are available for over 60 countries (>50% of viremic infections), with more countries anticipated to be verified over the next few years HCV prevalence updates will be published and updated on the Polaris Observatory website (http://polarisobservatory.com) on an annual basis to track the progress of HCV elimination efforts Source: Gower E, Estes C, Blach S, Razavi-Shearer K, Razavi H. Global epidemiology and genotype distribution of the hepatitis C virus infection. Journal of Hepatology 2014; 61(1S): S45-S57.

Appendix

HCV: Validated disease burden analyses completed – analysis reviewed and approved by local experts (60 countries/regions) Africa Australia Oman Denmark Malta Cameroon Bahrain Pakistan Estonia Netherlands Egypt Hong Kong Qatar European Union Norway Ethiopia India Saudi Arabia Finland Poland Ghana Indonesia South Korea France Portugal Nigeria Iran Taiwan Germany Romania South Africa Israel Turkey Greece Russia Americas Japan UAE Hungary Slovakia Argentina Jordan Europe Iceland Slovenia Brazil Lebanon Austria Ireland Spain Canada Malaysia Belgium Latvia Sweden Mexico Mongolia Croatia Lithuania Switzerland Asia/ Pacific New Zealand Czech Republic Luxembourg

HCV: Validated disease burden analyses underway (7 countries) Americas Africa Asia/ Pacific Europe Chile Uganda Philippines Bulgaria Colombia Viet Nam Kuwait

HCV: Disease burden models built based on published data (35 countries/regions) Africa Americas Asia/ Pacific Europe Algeria Dominican Republic Azerbaijan Albania Burkina Faso Panama Cambodia Italy Burundi Puerto Rico China United Kingdom Central African Republic United States Georgia Chad Iraq Gabon Kazakhstan Kenya Papua New Guinea Libya Singapore Madagascar Syria Malawi Thailand Morocco Ukraine Tunisia Uzbekistan Uganda Venezuela Zimbabwe Yemen

HCV: Disease burden models built based on analogues or regional averages (58 countries/regions) Africa Niger El Salvador Myanmar Angola Republic of Congo Guadeloupe Nepal Benin Rwanda Guatemala North Korea Botswana Senegal Haiti Palestine DRC Sierra Leone Honduras Sri Lanka Eritrea Somalia Jamaica Tajikistan Gambia South Sudan Nicaragua Turkmenistan Guinea Sudan Paraguay Europe Guinea-Bissau Tanzania Peru Belarus Ivory Coast Togo Uruguay Bosnia & Herzegovina Lesotho Zambia Asia/ Pacific Cyprus Liberia Americas Afghanistan Macedonia Mali Bolivia Armenia Moldova Mauritania Costa Rica Bangladesh Serbia Mozambique Cuba Kyrgyzstan Namibia Ecuador Laos

Comparison of Gower 2014 anti-HCV estimates with other published work

Comparison of Gower 2014 viremic HCV estimates with present analysis

80% of the change in prevalence was attributable to 32 countries Nigeria accounted for ~35% of the change in global prevalence, before considering its impact on regional estimates

9 countries with the largest impact were using regional estimates