The United Nations World Health Organization (WHO) has issued its first guidelines for the treatment of hepatitis C, a chronic infection that affects an estimated 130 million to 150 million people, in a bid to help improve access to more effective and safer medicines to those who need them.
“The new guidance aims to help countries to improve treatment and care for hepatitis and thereby reduce deaths from liver cancer and cirrhosis,” Dr. Stefan Wiktor, leading WHO’s Global Hepatitis Programme, said in a news release.
The publication of the guidelines coincides with the availability of more effective and safer oral hepatitis medicines, along with the promise of even more new medicines in the next few years, to tackle a disease that results in 350,000 to 500,000 deaths a year.
WHO will be working with countries to introduce the guidelines as part of their national treatment programmes. The agency’s support will include assistance to make the new treatments available and consideration of all possible avenues to make them affordable for all, as well as an assessment of the quality of hepatitis laboratory tests and generic forms of hepatitis medicines.
“Hepatitis C treatment is currently unaffordable to most patients in need. The challenge now is to ensure that everyone who needs these drugs can access them,” says Dr. Peter Beyer, Senior Advisor for the Essential Medicines and Health Products Department at WHO.
“Experience has shown that a multi-pronged strategy is required to improve access to treatment, including creating demand for treatment. The development of WHO guidelines is a key step in this process.”
The new guidelines, launched on the eve of the opening of the 2014 International Liver Congress in London, make nine key recommendations. These include approaches to increase the number of people screened for hepatitis C infection, advice as to how to mitigate liver damage for those who are infected and how to select and provide appropriate treatments for chronic hepatitis C infection.
WHO recommends a screening test for those considered at high risk of infection, followed by another test for those who screen positive, to establish whether they have chronic hepatitis C infection.
Since alcohol use can accelerate liver damage caused by hepatitis C, WHO now advises that people with chronic hepatitis C infection receive an alcohol assessment. The agency also recommends providing counselling to reduce alcohol intake for people with moderate or high alcohol use. In addition, the guidelines provide advice on the selection of the most appropriate test to assess the degree of liver damage in those with chronic hepatitis C infection.
As for treatment, the guidelines provide recommendations on existing treatments based on interferon injections as well as the new regimens that use only oral medicines. WHO will update recommendations on drug treatments periodically as additional antiviral medicines are registered on the market and new evidence emerges.
The recommendations also include interventions that should be put in place to prevent transmission of hepatitis C, including measures to assure the safety of medical procedures and injections in health care settings and among persons who inject drugs.
WHO pointed out that rates of new hepatitis C infections remain “unacceptably high” in many countries due to the reuse of injection equipment and lack of screening of blood transfusions.
“Many people remain unaware – sometimes for decades – that they are infected with hepatitis C,” says Dr. Andrew Ball, Senior Advisor for Policy, Strategy and Equity for WHO’s HIV/AIDS Department, where the Global Hepatitis Programme is housed.
“Today’s launch highlights the need for more awareness and education on hepatitis for the general public. Greater awareness on the risks associated with hepatitis C should lead to a demand for services and expansion of laboratory capacity and clinical services so that more people can be tested, treated and cured.”
There are five main hepatitis viruses, referred to as types A, B, C, D and E. Hepatitis B and C have the greatest public health impact because they cause chronic infection which can progress to cirrhosis and liver cancer. Hepatitis A and E, spread though unsafe water and contaminated food, have the potential to cause outbreaks in certain populations.
The hepatitis C virus is most commonly transmitted through exposure to contaminated blood. Those at risk include people undergoing invasive medical procedures and therapeutic injections where there is poor infection control. Also at risk are those exposed to contaminated injecting and skin piercing equipment, including through injecting drug use, tattooing and body piercing.