Originally published by our sister publication Pharmacy Practice News
By Ethan Covey
Despite efforts to eliminate hepatitis B virus (HBV), millions of people around the world live with chronic HBV infection. During a session at the AIDS 2024 conference, experts discussed the current state of HBV elimination and the rationale for the new guidelines developed by the WHO.
“According to recent data from WHO, there are around 300 million people living with chronic hepatitis B or C worldwide,” said Hugo Perazzo, MD, PhD, a hepatologist and researcher at the Instituto Nacional de Infectologia Evandro Chagas in Rio de Janeiro, who moderated the session. “In 2022, there were 2.2 million new infections—1.2 million hepatitis B and nearly 1 million hepatitis C.”
Dr. Perazzo noted that “viral hepatitis is not gone-not yet.”
Polin Chan, MD, the regional advisor for HIV/Hepatitis/STI/EMTCT, WHO Southeast Asia Regional Office, in New Delhi, who discussed the updated guidelines, noted that recent years have seen numerous interventions to improve prevention, diagnosis and treatment of hepatitis B and C.
However, major gaps in testing and treatment uptake have been identified.
“There are 254 million people living with hepatitis B, and as of 2022, only 13% were being diagnosed and only 3% have received treatment for hepatitis B. We still have a long way to go,” Dr. Chan said.
In addition, recent studies have begun to focus on differences in regional demographics and epidemiology, and emerging evidence continues to alter the global understanding of HBV.
“We realized that 25% of all hepatitis B−positive people in sub-Saharan Africa were younger than 25 years old, and liver cancers are happening at a much younger age in that region,” Dr. Chan said. “[Additionally,] the uptake of birth dose [of HepB vaccine] in sub-Saharan Africa and other regions still lags behind, and in many regions we are nowhere near the coverage of 90% that we are aiming for.”
Recognizing these gaps, as well as frequent complaints that the existing guidelines were too complex, necessitated reevaluating the existing guidelines, which were first released in 2015 and then updated in 2017 and 2020.
The updated guidelines include 29 recommendations, of which 14 are new. They are addressed primarily to clinicians and national hepatitis program managers and other policymakers in health ministries, particularly in low- and middle-income countries, who are responsible for developing national hepatitis testing and treatment plans, policy and guidelines.
Components include expanded and simplified treatment criteria for both 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 virus coinfection, using testing protocols, and approaches for delivering high-quality HBV services.
According to Dr. Chan, the paradigm shift in the new guidelines is the recommendation to now treat all adults and adolescents ages 12 years and older with chronic HBV, including pregnant women and girls, and women of reproductive age.
“[This] will mean many more people can get into treatment, and the decision point will be at the clinical level,” Dr. Chan said. “It will also mean that many more pregnant and nonpregnant women can be provided treatment for their own health, and not only access to antiviral drug use during pregnancy.”
Dr. Chan also stressed the ultimate importance of increasing the availability of, and access to, testing.
“Today, in every country and every region we have similar challenges, but most importantly-like with HIV-[the answer] is test, test, test,” Dr. Chan said. “Test in any opportunity in all health programs so that we can do case finding and link individuals to treatment.”
The U.S. Experience
In the United States, data from the Viral Hepatitis National Progress Report show that the number of estimated new HBV infections was relatively stable at around 20,000 infections annually during 2015 through 2019, decreased substantially in 2020, and then remained relatively stable in 2021 and 2022.
“Continued efforts are needed to implement CDC’s expanded hepatitis B vaccination recommendations and hepatitis B screening and testing recommendations among adults, improve appropriate testing and linkage to care, and reduce hepatitis B−related health disparities,” said Rachel Wingard, a spokesperson with the news media team of the Health Communication Science Office, CDC.