The World Health Organization (WHO) has released new guidelines on the prevention, diagnosis, and treatment of chronic Hepatitis B (HBV) infection. 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. 

Background Information:

Hepatitis B virus (HBV) infection is a major public health problem and cause of chronic liver disease that led to an estimated 1.1 million deaths in 2022, mainly due to cirrhosis and liver cancer. In 2022, WHO estimated that 253 million people were chronically infected and living with hepatitis B, of whom 63% are in the African and Western Pacific Asian region.

Most of the global burden of chronic hepatitis B (CHB) is due to mother-to-child transmission at or shortly after birth.

Considerable progress has been made towards eliminating the perinatal transmission of HBV through universal infant HBV immunization, including the timely hepatitis B birth-dose (HepBD), which has been highly effective in reducing new infections among children. However, HepBD coverage is only 45% globally, with lowest coverage (18%) in the WHO African Region.

For people with CHB infection, nucleoside analogue treatment with currently recommended tenofovir and entecavir is highly effective and can reduce progression of liver disease and incidence of hepatocellular carcinoma (HCC) and improve long-term survival. However, a major testing and treatment gap remains. In 2022, only 13% of the estimated 253 million people with CHB had been diagnosed and 3% had been treated.

Key Messages:

The objective of the 2024 guidelines is to provide updated evidence-informed recommendations on key priority topics. These include

• expanded and simplified treatment criteria for adults but now also for adolescents;
• expanded eligibility for antiviral prophylaxis for pregnant women to prevent mother-to-child transmission of HBV;
• improving HBV diagnostics through use of point-of-care HBV DNA viral load and reflex approaches to HBV DNA testing;
• and who to test and how to test for HDV infection.

The 2024 guidelines include 11 updated chapters with new recommendations:

Expanded treatment and antiviral prophylaxis

• use of non-invasive tests for staging of liver disease (Chapter 4);
• who to treat among people with CHB (Chapter 5);
• first-line antiviral therapies for CHB (Chapter 6);
• preventing mother-to-child transmission of HBV using antiviral prophylaxis (Chapter 7);
• treatment of adolescents and children with CHB (Chapter 8);
  
  HBV DNA and HDV infection diagnostics
• measurement of HBV DNA level to guide treatment eligibility and monitor treatment response (Chapter 10);
• HBV DNA reflex testing (Chapter 11);
• HDV testing – who to test and how to test, including reflex testing (Chapters 12–14); and

HBV service delivery

• Eight approaches to promote access and delivery of high-quality health services for CHB (no new recommendations but includes existing recommendation on strategies to promote linkage to care) (Chapter 15).
  
  There are also five existing chapters relating to monitoring with unchanged recommendations from the 2015 guidelines, but these have been updated with new context, additional studies and new research gaps. These chapters are:
• second-line antiviral therapies for managing treatment failure (Chapter 9);
• monitoring for treatment response, and for treatment side effects (Chapters 16–17);
• surveillance for HCC (Chapter 18);
• when to stop and restart antiviral therapy (Chapter 19).

Useful Links:

Link to the new Guidelines:

https://www.who.int/publications/i/item/9789240090903

Link to the Policy Brief:

https://www.who.int/publications/i/item/9789240091368

Link to the related WHO news release:

https://www.who.int/news/item/29-03-2024-who-publishes-updated-guidelines-on-hepatitis-b