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National strategy for elimination of liver diseases in Taiwan
Chien-Jen Chen1, Chao-Chun Wu2, Shi-Lun Wei2
1Genomics Research Center, Academia Sinica, Taipei, Taiwan.
Insights
Taiwan
Area of Science:
- Hepatology
- Public Health
- Epidemiology
Background:
- Chronic liver diseases (CLD), including cirrhosis and hepatocellular carcinoma (HCC), are leading causes of death in Taiwan.
- Chronic hepatitis B virus (HBV) and hepatitis C virus (HCV) infections are primary drivers of end-stage liver disease in Taiwan.
- Long-term cohort studies (GECC and REVEAL) provide data on liver disease trends.
Purpose of the Study:
- To evaluate the effectiveness of public health interventions for CLD and HCC in Taiwan.
- To assess the impact of the HBV immunization program and antiviral treatment programs.
- To project the achievement of World Health Organization (WHO) HCV elimination targets.
Main Methods:
- Age-period-cohort analysis of liver disease mortality data.
- Evaluation of nationwide HBV immunization program (initiated 1984).
- Assessment of chronic viral hepatitis treatment program (initiated 2003) and HCV elimination program (initiated 2017).
Main Results:
- HBV immunization significantly reduced CLD mortality by 82% and HCC mortality by 63% in immunized cohorts.
- Antiviral treatment programs led to significant reductions in CLD (26%) and HCC (50%) mortality from 2004-2018.
- Taiwan is on track to achieve WHO HCV elimination targets by 2025 through nationwide screening and care cascade management.
Conclusions:
- The HBV immunization program has demonstrated high effectiveness in reducing liver disease mortality in Taiwan.
- Antiviral treatment and HCV elimination programs are significantly contributing to decreased CLD and HCC mortality.
- Taiwan's comprehensive strategy is expected to achieve WHO HCV elimination goals by 2025.
Abstract:
Chronic liver diseases (CLD) including cirrhosis and hepatocellular carcinoma (HCC) have been major causes of death in Taiwan for at least six decades in Taiwan. Based on the long-term follow-up studies of GECC and REVEAL cohorts, chronic infections of hepatitis B virus (HBV) and hepatitis C virus (HCV) have been well-documented as major causes of end-stage liver diseases in Taiwan. The nation-wide HBV immunization program was implemented in 1984, and the chronic viral hepatitis treatment program was launched in 2003 in Taiwan. Based on the age-period-cohort analysis of liver disease mortality in Taiwan, there was a significant reduction in the mortality from CLD (82 %) and HCC (63 %) for the immunized birth cohorts compared with unimmunized birth cohorts, showing the high effectiveness of HBV immunization program. There was also a significant reduction in the mortality from CLD (26 %) and HCC (50 %) from 2004 to 2018, showing the significant effectiveness of anti-viral treatment program. Taiwan started a national HCV elimination program in 2017 to reach 2030 targets proposed by World Health Organization (WHO) by 2025. Through the nation-wide screening of high-risk and general population, stringent follow-up of care cascade, and continuous monitoring, the WHO programmatic targets will be achieved in 2025.
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