World Health Organization (WHO) today issued its first-ever guidance for the treatment of chronic hepatitis B, a viral infection which is spread through blood and body fluids, attacking the liver and resulting in an estimated 650,000 deaths each year most of them in low and middle-income countries.
Worldwide, some 240 million people have chronic hepatitis B virus with the highest rates of infection in Africa and Asia. People with chronic hepatitis B infection are at increased risk of dying from cirrhosis and liver cancer.
Effective medicines exist that can prevent people developing these conditions so they live longer. But most people who need these medicines are unable to access them or can only obtain substandard treatment. One reason for this is the lack of clear evidence-based guidance for countries (especially low- and middle-income countries) as to who should be treated and what medicines to use.
"Deciding who needs treatment for hepatitis B depends on a number of factors," says Dr Stefan Wiktor, who leads WHO's Global Hepatitis Programme. "These new guidelines, which give treatment recommendations that rely on simple, inexpensive tests, will help clinicians make the right decisions".
The "WHO guidelines for the prevention, care and treatment of persons living with chronic hepatitis B infection" lay out a simplified approach to the care of people living with chronic hepatitis B, particularly in settings with limited resources.
The guidance covers the full spectrum of care from determining who needs treatment, to what medicines to use, and how to monitor people long-term.
Key among the recommendations are the use of simple tests to assess the stage of liver disease and to help identify who needs treatment; prioritizing the treatment of those with cirrhosis; the use of two safe and highly effective medicines, tenofovir or entecavir; regular monitoring and consideration of the special needs of specific populations, such as people co-infected with HIV, as well as children, adolescents and pregnant women.
A number of countries are beginning to develop hepatitis B treatment programmes, and the newly-released document also provides guidance on how to organize hepatitis care and treatment services.