WHO releases new guideline on prevention, diagnosis, and treatment of chronic hepatitis B infection

The 2024 HBV guidelines provide updated evidence-informed recommendations on key priority topics. These include substantial simplification and expansion of eligibility for treatment to overcome barriers to access to HBV testing and treatment.

The 2024 guidelines include 11 updated chapters with new recommendations and also update existing chapters without new recommendations, such as those on treatment monitoring and surveillance for liver cancer.

More than 250 million people are affected by chronic hepatitis B infection, leading to increasing deaths each year. Most of the global burden of chronic hepatitis B (CHB) is due to mother-to-child transmission at or shortly after birth. WHO’s Global health sector strategy sets actions and targets to eliminate viral hepatitis by 2030 by driving new infections and deaths down to half a million each globally – a reduction of 90% and 65%, respectively.

There has been considerable progress in eliminating mother-to-child transmission of HBV through universal HBV immunization, including the timely hepatitis B birth dose. However, hepatitis B birth-dose coverage is only 45% globally, with less than 20% coverage in the WHO African Region.

For patients with CHB infection, antiviral treatment is highly effective. It can reduce the progression of liver disease and improve survival and liver cancer development. However, major testing and treatment gaps remain.

HBV infection is a major public health problem and cause of chronic liver disease. 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 patients diagnosed with chronic hepatitis B infection and the 2017 WHO Guidelines on hepatitis B and C testing. These priority areas are:

• expanded treatment eligibility and inclusion of adolescents;
• expanded eligibility for antiviral prophylaxis among pregnant women to prevent mother-to-child transmission;
• alternative antiviral therapy regimens;
• testing for hepatitis delta coinfection;
• HBV diagnostics – use of point-of-care (POC) DNA assays and reflex HBV DNA testing; and
• approaches to promote the delivery of high-quality HBV services, including strategies to promote adherence to long-term antiviral therapy and retention in care.

The recommendations 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; who to test and how to test for HDV infection; and approaches to promote delivery of high-quality HBV services, including strategies to promote the adherence to long-term antiviral therapy and retention in care.

These guidelines also update existing chapters without new recommendations, such as those on treatment monitoring and surveillance for liver cancer.