WHO issues new Hepatitis B guidelines

The World Health Organisation has issued guidelines to simplify diagnosis and treatment of Hepatitis B. The new guidelines come one year after the United Nation’s health agency published the first ever rules on treating Hepatitis C. Hepatitis B is a viral infection that is spread through blood and body fluids, attacking the liver and resulting in an estimated 650,000 deaths each year — most of them in low- and middle-income countries. The guidelines for the prevention, care and treatment of persons living with chronic Hepatitis B infection include the use of fewer, simple and non-invasive tests to assess the stage of the liver disease. They aim at helping identify who needs treatment; prioritising treatment for those with an advanced stage of the disease; the use of two safe and highly effective medicines, tenofovir or entecavir, and regular monitoring with simple tests for early detection. Assessing efficacy of treatment (and if it can be stopped); and the needs of specific persons such as those also infected with HIV, children, adolescents, and pregnant women are also considered under the new guidelines. A survey carried out in 2012 on 12,000 pregnant women in selected health facilities in Rwanda, found 3.7 per cent of them with Hepatitis B and 2.6 per cent with Hepatitis C. “It is an indication of the severity of the problem,” says Stany Ngarukiye, a public health specialist at Mount Kenya University and member of the Rwanda Organisation for Fighting against Hepatitis (ROFAH). Dr Aimable Mbituyumuremyi, the Director of other blood born Infections unit at Rwanda Biomedical Centre (RBC), says that four out of every 100 people in the country have Hepatitis C. He added that another study carried out between 2013 and 2014 in Kigali showed that 5 per cent of HIV positive people were found to have Hepatitis B. “We found Hepatitis B commonest around border areas, perhaps because of high levels of prostitution,” Mbituyumuremyi says. The two diseases are not covered by community based public health insurance, Mutuelle De santé, making treatment expensive. “Treatment of Hepatitis C takes about 42 to 48 weeks, at a cost ranging from Rwf8 to 12 million”. Currently children access Hepatitis B vaccines free of charge, but an adult has to part with about Rwf27,000 for the whole vaccine dose.A single test for Hepatitis B and C ranges between Rwf4,000 and Rwf5,000. “We have not carried out a survey to ascertain the number of hospitals offering that kind of care, but all I know is that the four referral hospitals in the country do,” Ngarukiye said. He noted that there was need for a countrywide survey to ascertain the scope of the Hepatitis problem, as the existing figures are for pregnant women from a few health facilities. “The biggest challenge with Hepatitis B and C is that one can go for up to 30 years without noticing, since signs and symptoms take long to show up. It is, therefore, important for anyone who has never gone for screening to do so” Global perspective Effective medicines exist that can prevent people from developing these conditions but most people are unable to access them or can only obtain substandard treatment. “One reason for this is the lack of clear evidence-based guidance, especially in low- and middle-income countries, as to who should be treated and what drugs to use,” said Stefan Wiktor, who leads the WHO Global Hepatitis Programme. The two recommended medicines are available in many countries as generics, and are relatively affordable, costing as little as $5 per person per month. “Because for many people, treatment is lifelong. It is important that patients access the medicine at the lowest possible price,” said Dr Wiktor. About 350 million people around the world have Hepatitis B, while 210 million have Hepatitis C, according to the WHO—with the two accounting for almost 80 per cent of all liver cancer cases. Information from the same organisation shows that HIV and Hepatitis C have common routes of transmission and approximately 4 to 5 million are co-infected with these two viruses. The transmission risk is estimated at four to eight per cent among mothers without HIV infection and 17 to 25 per cent among mothers with HIV infection.

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WHO issues new Hepatitis B guidelines