By: Tim Yayasan Peduli Hati Bangsa, 23 April 2024
WHO has released new Guidelines on the prevention, diagnosis and treatment of chronic hepatitis B (HBV) infection at the Asia Pacific Conference for the Study of Liver Diseases (APASL) 2024 in Kyoto, Japan. Recommendations from these guidelines were also presented at the 2024 World Hepatitis Summit which was held in Lisbon, Portugal on 9-11 April 2024.
This guideline simplifies and expands the eligibility/feasibility of treatment for people with Hepatitis B virus (HBV).
More than 250 million people live with chronic hepatitis B infection, which causes a mortality increase every year. Most of the global burden of chronic hepatitis B is caused by mother-to-child transmission at or shortly after birth. The WHO global health sector strategy sets out actions and targets to eliminate viral hepatitis by 2030 by reducing new infections by 90% and reducing the death rate by half a million people (65%) globally.
Great progress has been made in eliminating mother-to-child transmission of HBV through universal HBV immunization of infants, including administration of hepatitis B doses immediately after birth. However, birth dose hepatitis B coverage is only 45% globally, with coverage of less than 20% in the African Region.
For people living with chronic Hepatitis B, antiviral treatment is very effective. This may increase survival and reduce the progression of liver disease and the development of liver cancer. However, there is still a large gap in the number of people seeking testing and treatment.
The updated guidelines released in 2024 prioritize simplified treatment criteria for adults and adolescents and expand eligibility for antiviral prophylaxis for pregnant women to prevent mother-to-child transmission of HBV. The guidance also focuses on improving HBV diagnostics through point-of-care viral load testing, addressing the diagnosis of Hepatitis Delta co-infection – a major cause of HBV-related morbidity and mortality – using testing protocols and approaches to deliver high-quality HBV services.
Guideline Summary
HBV infection is a major public health problem and a cause of chronic liver disease. These new guidelines provide up-to-date, evidence-based recommendations on priority HBV-related topics from the 2015 WHO Guidelines for the care and treatment of people diagnosed with chronic hepatitis B infection and the 2017 WHO Guidelines on hepatitis B testing and C. The priority areas are:
- Expanding treatment eligibility, and youth inclusion;
- Alternative antiviral therapy regimens;
- Expanding eligibility for antiviral prophylaxis among pregnant women to prevent mother-to-child transmission;
- HBV diagnostics – use of point-of-care (POC) DNA testing and HBV DNA reflex testing;
- Hepatitis delta co-infection testing; And
- approaches to encourage the delivery of high-quality HBV services, including strategies to improve adherence to long-term antiviral therapy and retention in care.
These guidelines also still include unchanged recommendations such as recommendations regarding treatment monitoring and liver cancer surveillance.
A summary of the Guidelines can be downloaded via the following link.