The World Health Organization (WHO) today released guidelines for the treatment of Chronic Hepatitis B (CHB).
CHB is defined as persistence of hepatitis B surface antigen (HBsAg) for six months or more, and is estimated to affect 240 million people worldwide.
The major complications of CHB are cirrhosis and hepatocellular carcinoma (HCC). Between 20% and 30% of those who become chronically infected will develop these complications, and an estimated 650 000 people will die annually from HCC and cirrhosis due to CHB.
The majority of people are unaware of their HBV infection, and therefore often present with advanced disease.
Although many countries (including India) have introduced Hepatitis B vaccination for infants, it will take many years for these programmes to have an impact on HBV-related deaths.
1. Non-invasive assessment of liver disease stage at baseline and during follow up
Resource-limited settings: APRI (aspartate aminotransferase [AST]-to-platelet ratio index) is recommended to assess for cirrhosis. APRI >2 indicates presence of cirrhosis.
Other settings: Transient elastography (FibroScan or FibroTest) may be performed where available and cost is not a major concern.
2. Who to treat and Who Not to treat in persons with Chronic Hepatitis B
Who to Treat
As a Priority: All adults, adolescents and children with CHB AND clinical evidence of compensated or decompensated cirrhosis (or cirrhosis based on APRI score >2 in adults) should be treated, regardless of ALT levels, HBeAg status or HBV DNA levels.
Treatment Recommended for: Adults with CHB but without evidence of cirrhosis but >30 years age AND persistently abnormal ALT levels AND HBV DNA >20 000 IU/mL, regardless of HBeAg status.
Who Not to Treat but continue to monitor
Antiviral therapy can be deferred in persons with CHB without cirrhosis (or APRI <2) AND persistently normal ALT levels AND HBV DNA <2000 IU/mL, regardless of HBeAg status or age.
Treatment is recommended with Nucleos(t)ide Analogues (NAs)
Note: The treatment algorithm above is a snapshot of the same as found in the guideline document. The resolution may be sub-optimal, though legible.
Link to the News release:
Link to the Policy Brief (10 pages):
Link to the complete Guidelines (166 pages):