WHO issues its first hepatitis B treatment guidelines

The World Health Organization on Thursday 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.

In a press statement, WHO noted that globally, 240 million people had 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 do 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 sub-standard 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,” said 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.”

Key recommendations in the "WHO guidelines for the prevention, care and treatment of persons living with chronic hepatitis B infection" include the use of a few simple non-invasive tests to assess the stage of liver disease to help identify who needs treatment; prioritising treatment for those with cirrhosis - the most advanced stage of liver disease; the use of two safe and highly effective medicines, tenofovir or entecavir, for the treatment of chronic hepatitis B; and regular monitoring using simple tests for early detection of liver cancer, to assess whether treatment is working, and if treatment can be stopped.

The special needs of specific populations, such as people co-infected with HIV, as well as children and adolescents, and pregnant women are also considered.

The two recommended medicines are already available in many countries as generics, and thus are relatively inexpensive, costing as little as US $ 5 per person per month. “Because for so many people treatment is life-long, it is important that patients can access these medicines at the lowest possible price” said Wiktor.

The guidelines also provide guidance on how to organise hepatitis care and treatment services. “For example, countries need to think about ways to improve access to medicines and how best to deliver quality care that builds on existing health services and staff,” said Philippa Easterbrook, from the WHO Global Hepatitis Programme.

The new guidelines on treating hepatitis B follow on from the publication last year by WHO of its first ever guidelines on treating hepatitis C.