WHO 2024 hepatitis B guidelines: an opportunity to transform care

Chronic hepatitis B virus (HBV) infection is a major public health problem and cause of chronic liver disease and led to an estimated 1·1 million deaths in 2022, mainly due to cirrhosis and hepatocellular carcinoma. 1 WHOGlobal hepatitis report 2024: action for access in low- and middle-income countries. World Health Organization, Geneva2024https://www.who.int/publications/i/item/9789240091672Date accessed: April 9, 2024 Google Scholar In 2022, WHO estimated that 254 million people were living with chronic hepatitis B, of whom 65% were in the African and Western Pacific regions. 1 WHOGlobal hepatitis report 2024: action for access in low- and middle-income countries. World Health Organization, Geneva2024https://www.who.int/publications/i/item/9789240091672Date accessed: April 9, 2024 Google Scholar Most of this global burden can be attributed to mother-to-child transmission at the time of or shortly after birth and horizontal household transmission. Considerable progress has been made towards eliminating perinatal transmission of HBV through universal infant HBV immunisation, including timely hepatitis B birth-dose vaccination administered within 24 h of birth. This regimen is 90–95% effective in preventing infection and in reducing new infections among children. However, hepatitis B birth-dose coverage is only 45% globally, with particularly low coverage (18%) in the WHO African region. 2 WHOImmunization coverage. https://www.who.int/news-room/fact-sheets/detail/immunization-coverageDate accessed: March 14, 2024 Google Scholar For people with chronic hepatitis B, nucleoside analogue treatment with tenofovir or entecavir is highly effective, reducing progression of liver disease and incidence of hepatocellular carcinoma and improving long-term survival. However, a major testing and treatment gap remains. In 2022, only 13% of those living with chronic hepatitis B had been diagnosed and 3% treated. 1 WHOGlobal hepatitis report 2024: action for access in low- and middle-income countries. World Health Organization, Geneva2024https://www.who.int/publications/i/item/9789240091672Date accessed: April 9, 2024 Google Scholar Scaling up testing and treatment to reach the 90% testing and 80% treatment coverage targets and achieve the elimination goals will require radical simplification of treatment criteria, diagnostic approaches, and care pathways to overcome barriers in access to hepatitis B testing and treatment.