Chronic hepatitis B infection affects over 250 million people worldwide, leading to a concerning rise in fatalities each year.
The World Health Organization (WHO) has unveiled groundbreaking guidelines for the prevention, diagnosis, and treatment of chronic hepatitis B (HBV) infection at the 2024 Asian Pacific Conference for the Study of Liver Disease (APASL) in Kyoto, Japan. These guidelines mark a significant step forward in addressing the global burden of HBV by simplifying treatment criteria and expanding access to essential testing and treatment services.
Chronic hepatitis B infection affects over 250 million people worldwide, leading to a concerning rise in fatalities each year. A substantial portion of this burden stems from mother-to-child transmission, either during birth or shortly after. WHO’s Global health sector strategy aims to eliminate viral hepatitis by 2030, targeting a 90% reduction in new infections and a 65% reduction in HBV-related deaths globally.
While progress has been made in preventing mother-to-child transmission through universal infant HBV immunization, coverage of the hepatitis B birth dose remains low, particularly in the WHO African Region, where it sits below 20%. To address these challenges, the new guidelines prioritize simplified treatment criteria for adults and adolescents and advocate for expanded eligibility for antiviral prophylaxis among pregnant women to prevent transmission to their newborns.
Antiviral treatment for individuals with CHB infection has demonstrated high efficacy in improving survival rates, slowing the progression of liver disease, and reducing the risk of liver cancer. However, significant gaps persist in testing and treatment access, hindering efforts to curb the HBV epidemic.
Key components of the 2024 guidelines include:
- Expanded Treatment Eligibility: The guidelines broaden the criteria for initiating antiviral therapy, making treatment more accessible to a larger population, including adolescents.
- Alternative Antiviral Therapy Regimens: The recommendations include alternative antiviral therapy regimens to cater to diverse patient needs and circumstances.
- Antiviral Prophylaxis for Pregnant Women: Pregnant women with HBV can now benefit from expanded eligibility for antiviral prophylaxis, significantly reducing the risk of mother-to-child transmission.
- Enhanced HBV Diagnostics: The guidelines advocate for the use of point-of-care (POC) DNA assays and reflex HBV DNA testing to improve diagnostic accuracy and efficiency.
- Testing for Hepatitis Delta Coinfection: Addressing hepatitis delta coinfection, a major cause of HBV-related morbidity and mortality, is emphasized through specific testing protocols.
- Promoting High-Quality HBV Services: Strategies to enhance the delivery of high-quality HBV services, including measures to promote adherence to long-term antiviral therapy and retention in care, are outlined.
These guidelines build upon previous recommendations from the 2015 WHO Guidelines for the care and treatment of persons diagnosed with chronic hepatitis B infection and the 2017 WHO Guidelines on hepatitis B and C testing. They encompass critical areas such as treatment eligibility, antiviral therapy regimens, prophylaxis for pregnant women, HBV diagnostics, testing for hepatitis delta coinfection, and strategies for delivering quality HBV services.
In addition to addressing priority areas, the guidelines also update existing chapters on treatment monitoring and surveillance for liver cancer to ensure comprehensive care for individuals with CHB infection.
In conclusion, the release of WHO’s new guidelines at the 2024 APASL conference represents a significant milestone in the global fight against chronic hepatitis B. By simplifying treatment criteria, expanding access to essential services, and advocating for comprehensive care, these guidelines pave the way for improved outcomes and a reduced burden of HBV-related morbidity and mortality worldwide.