TREATMENT OF CHRONIC HEPATITIS B VIRUS INFECTION IN RESOURCE-CONSTRAINED SETTINGS: EXPERT PANEL CONSENSUS

An estimated 350 million people have chronic hepatitis B virus (HBV) infection and most of them live in resource-constrained settings. Up to 25% of those persons will die prematurely of hepatocellular carcinoma (HCC) or cirrhosis. Universal hepatitis B immunization programmes that target infants will have an impact on HBV-related deaths several decades after their introduction. Treatment of HBV infection in those who need it has been shown to reduce the risk of HCC and death. It is estimated that 20-30% of persons with HBV infection will benefit from treatment. There are antiviral drugs active against HBV; however, they are not widely available or utilized in persons infected with HBV. Currently recommended antiviral agents used for treatment of human immunodeficiency virus (HIV) infection do not adequately suppress HBV replication, which is of great concern for 10% of the HIV-infected persons in Africa who are diagnosed as being co-infected with HBV. Progressive liver disease has been found to occur in co-infected persons who take no drugs to suppress HBV. In view of these problems, an informal World Health Organization (WHO) consultation of experts concluded that: chronic HBV is a major public health problem in developing countries; all HIV-infected persons should be screened for HBV infection; HIV/HBV co-infected persons should be treated with therapies that are active against both viruses and that reduce the risk of resistance; standards for the management of chronic HBV infection should be adapted to resource-constrained settings. In addition, a research agendum has been developed mainly to prevent and treat chronic HBV infection in resource-constrained settings. The WHO is developing guidelines for the management of chronic HBV infection in resource-constrained settings. An informal WHO technical consultation was held to have expert data for next steps to solve the serious public health problem related to HBV infection and its associated disease burden. It was attended by the representatives of professional medical associations dealing with the study of liver diseases, who are well familiar with guidelines for their treatment in resource-constrained setting, as well as by clinicians from resource-constrained countries and by the representatives of affiliated organizations. The conclusions and recommendations made by this consultation are not a portrayal of the official policy of the WHO and its official guidelines; however they will be of importance in meeting the demands of million HBV-infected people worldwide.

hepatitis B, constrained resources, treatment