In a significant stride towards the global management of chronic hepatitis B (CHB), the World Health Organization (WHO) unveiled its updated guidelines at the 2024 Asian Pacific Conference for the Study of Liver Disease held in Kyoto, Japan. These guidelines, aimed at preventing, diagnosing, and treating CHB, promise to make a substantial impact on public health due to the expanded treatment eligibility criteria and simplified approaches to care.
Chronic Hepatitis B remains a major public health concern, affecting over 250 million people worldwide and contributing increasingly to the global burden of liver disease and cancer.
What is Hepatitis B?
Dr Chetan Kalal, program director of liver, pancreas and intestine transplantation at Nanavati Max Super Specialty Hospital, Mumbai says, “Hepatitis B is a viral infection that primarily affects the liver, causing inflammation that can lead to severe complications”. Hepatitis B can be both acute as well as chronic.
“Acute hepatitis usually resolves with time, whereas chronic hepatitis leads to complications like cirrhosis, liver failure and even liver cancer,” says Dr Mallikarjun Sakpal, Consultant – HPB & Transplant Physician, Aster Whitefield Hospital, Bangalore.
It spreads through contact with infected blood or bodily fluids, commonly through unprotected sex, sharing needles, or from an infected mother to her newborn during childbirth. Precautions individuals can take include getting vaccinated against hepatitis B, practicing safe sex, avoid sharing needles or personal items such as toothbrushes or razors, and ensuring proper hygiene practices to prevent transmission. Apart from this, everyone in the family should get immunized and all family members must be screened if someone is affected with CHB.
Expanded Treatment Eligibility
The WHO’s revised guidelines broaden the eligibility for treatment to include not only adults but also adolescents and pregnant women.
Dr Kalal explains that this is a good move because by making treatment more accessible to a broader population, we can potentially reduce disease progression, lower transmission rates, and ultimately decrease the burden of hepatitis B-related liver complications and mortality worldwide.
Early detection and effective management of hepatitis B can help prevent disease progression and reduce the risk of liver-related complications. A notable advancement in the guidelines are:
- Emphasis on point-of-care viral load testing (measures the amount of HBV DNA in a person’s blood)
- Reflex HBV DNA testing (measures the amount of hepatitis B virus DNA in a serum or plasma sample).
“These rapid and accurate testing methods enable healthcare providers to assess disease status promptly, monitor treatment response, and make informed decisions regarding antiviral therapy initiation or adjustment,” says Dr Kalal.
Protecting future generations: Antiviral prophylaxis for pregnant women
“One of the most common modes of transmission is mother to child, especially in Asian countries, including India,” says Dr Sakpal. Which is why one of the most critical aspects of the new guidelines is the expanded eligibility for antiviral prophylaxis (administration of antiviral agents) among pregnant women. “New recommendations specify that all hepatitis B positive mothers can be given prophylaxis even if facilities for further testing is not available,” he added.
This is a lifelong treatment, and the medications are not stopped. It is to treat them and prevent transmission to other people. This measure is aimed directly at preventing the mother-to-child transmission of HBV. “By providing antiviral therapy during pregnancy to women with high viral loads, we can significantly reduce the risk of transmitting the hepatitis B virus to their newborns at birth,” adds Dr Kalal.
This proactive approach has the potential to prevent lifelong chronic infection in infants. Dr Sakpal explains that earlier the treatment starts in the pregnancy, lower is the risk of transmission, so there is enough time for the drugs and treatment to react.
Addressing hepatitis delta coinfection
Dr Sakpal explains that hepatitis delta virus is a liver infection that occurs only when Hepatitis B is already present. “If a person is affected with this virus, it means the infection is much more severe. They progress fast and end up in early liver failure,” he adds.
The guidelines also shed light on the importance of testing for hepatitis delta coinfection, which is linked to more severe disease progression. “By identifying and managing hepatitis delta coinfection early, one can implement appropriate treatment strategies and improve outcomes,” says Dr Kalal.
Experts add that however, there are challenges in implementation of this, because there is limited access to diagnostic testing and treatment options in certain regions, and less awareness in at-risk populations.
Dr Sakpal explains, “At the gross level, we have very preliminary tests which do not have good sensitivity to confirm. Even at community level, we need good quality tests like the ELISA test to detect hepatitis B. It should be available to everyone.” This is expensive, and not easily available. It also takes time, which is why there are issues in early detection and treatment of Hepatitis B.
Strategies for long-term management of hepatitis B
Maintaining long-term antiviral therapy and retention are strategies outlined in the WHO’s approach. “Strategies for promoting adherence to long-term antiviral therapy and retention in care include education and counseling, regular monitoring of viral load and liver function tests, addressing barriers to treatment access and adherence, and fostering a supportive healthcare environment,” says Dr Kalal.
“It is important to do community surveillance, find out some of the inactive carriers and check if they require treatment to prevent further transmission,” adds Dr Sakpal.
Beyond 2024
Speaking about the guidelines to Happiest Health, Dr Sakpal says, “it is very difficult as we still do not have medicines to cure hepatitis B, we can only control the virus,”.
Beyond the 2024 guidelines, additional advancements and areas of research are necessary to achieve the WHO’s goal of eliminating viral hepatitis by 2030. “Ongoing research into new treatment modalities, therapeutic vaccines, and strategies for hepatitis B cure is essential for improving long-term outcomes,” adds Dr Kalal.
Takeaways
- The WHO released new guidelines for the detection and treatment of chronic hepatitis B.
- The guidelines have expanded treatment options for adolescents and pregnant women as well.
- hepatitis B can spread through blood transfusions, mother to child, sexual contact.
- The guidelines also shed light on the importance of testing for hepatitis delta coinfection, which is linked to more severe disease progression.
- If one is affected with hepatitis B, it is important to take precautions and the whole family should get screened.
