"WHO Releases Updated Guidelines for Hepatitis B Management: Key Recommendations and Insights"

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29 March 2024

WHO has released new Guidelines on 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 provide a substantial simplification and expansion of eligibility for treatment to overcome barriers in access to HBV testing and treatment.

More than 250 million people live with chronic hepatitis B infection, leading to increasing deaths each year. Most of the global burden of chronic hepatitis B (CHB) is due to mother-to-child transmission at or shortly after birth. WHO’s Global health sector strategy sets actions and targets to eliminate viral hepatitis by 2030 by driving new infections and deaths down to half a million each globally – a reduction of 90% and 65%, respectively.

Considerable progress has been made towards eliminating mother-to-child transmission of HBV through universal infant HBV immunization, including the timely hepatitis B birth dose. However, hepatitis B birth-dose coverage is only 45% globally, with less than 20% coverage in the WHO African Region.

For people with CHB infection, antiviral treatment is highly effective. It can improve survival and reduce progression of liver disease and the development of liver cancer. However, major testing and treatment gaps remain.

The 2024 guidelines prioritize simplified treatment criteria for adults and adolescents and expanded eligibility for antiviral prophylaxis for pregnant women to prevent mother-to-child transmission of HBV. The guidelines also focus on enhancing HBV diagnostics through point-of-care viral load testing, addressing diagnosis of Delta coinfection – a major cause of HBV-related morbidity and mortality – using testing protocols, and approaches to delivering high-quality HBV services.

Overview

HBV infection is a major public health problem and cause of chronic liver disease The new guidelines provide updated evidence-based recommendations on the priority HBV-related topics 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. These priority areas are:

expanded treatment eligibility, and inclusion of adolescents;
alternative antiviral therapy regimens;
expanded eligibility for antiviral prophylaxis among pregnant women to prevent mother-to-child transmission;
HBV diagnostics – use of point-of-care (POC) DNA assays and reflex HBV DNA testing;
testing for hepatitis delta coinfection; and
approaches to promote delivery of high-quality HBV services, including strategies to promote adherence to long-term antiviral therapy and retention in care.

These guidelines also update existing chapters without new recommendations, such as those on treatment monitoring and surveillance for liver cancer.