UN guidelines aim to simplify care for millions infected with hepatitis B

With 650,000 deaths caused by hepatitis B each year, and with up to 240 million people worldwide infected with the virus’s chronic strain, the United Nations health agency today issued its first ever official guidance for treating the disease.

The disease, which is spread through blood and body fluids, attacks the liver and heightens the risk of dying from cirrhosis and liver cancer. Effective medicines exist that can prevent people developing such conditions, prolonging their lives but most people who need those medicines are unable to access them. One reason for that is the lack of clear guidelines on 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 the Global Hepatitis Programme at the World Health Organization (WHO). “These new guidelines, which give treatment recommendations that rely on simple, inexpensive tests, will help clinicians make the right decisions.”

WHO’s ‘Guidelines for the prevention, care and treatment of persons living with chronic hepatitis B infection’ lays out a simplified approach to care for 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; prioritising 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.

“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 Dr. Philippa Easterbrook, from the WHO Global Hepatitis Programme.

The two medicines recommended in the guidelines, tenofovir or entecavir, are already available in many countries as generics, and thus are relatively inexpensive, costing as little as $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 Dr. Wiktor.

Both drugs have a very low risk of developing resistance, are easy to take as one pill once a day, and have few side effects.

While treatment can prolong the lives of people already infected with hepatitis B, it is also important to focus on preventing new infections. WHO recommends that all children are vaccinated against the virus with a first dose given at birth, and some countries, especially in Asia, have reduced rates of infection through universal childhood vaccination.