Treatment & Care

Viral hepatitis infections are major causes of acute and chronic liver diseases globally and cause an estimated 1.4 million deaths annually. Around 96% of viral hepatitis deaths are attributable to complications of chronic hepatitis B virus (66%) infection and chronic hepatitis C virus (30%) infection from decompensated cirrhosis and hepatocellular carcinoma. Hepatitis D occurs HDV infection occurs only simultaneously or as super-infection with HBV. Hepatitis A and E cause fewer deaths, almost exclusively from acute hepatitis. 

Highly effective treatments are available for both HBV and HCV infections, with short course curative DAA treatment which has revolutionized treatment of hepatitis C infection, and long-term antiviral treatment with tenofovir or entecavir for people with chronic HBV infection, who are eligible for treatment. Antiviral treatment in of chronic hepatitis B and C infections aims to reduce morbidity and mortality by reducing the risk of related complications such as decompensated liver failure and hepatocellular carcinoma. In the absence of effective treatment, an estimated 20-30% of people with chronic HBV or chronic HCV will develop cirrhosis and are at risk of cirrhosis and cancer. Treating HBV and HCV co-infection among HIV infected persons helps secure the health gains from HIV treatment; and priority populations including PWID and prisoners and ensuring sufficient coverage of harm reduction interventions. 

Scaling up treatment of hepatitis B (HBV) and hepatitis C (HCV) infection is fundamental to reducing mortality as part of the Global Health Sector Strategy on viral hepatitis (GHSS) elimination goal will require a radical change in the hepatitis response including implementing a public health response. At baseline, only 4.5 million (17%) of people diagnosed with hepatitis B received treatment in 2016 whilst 5 million people diagnosed with hepatitis C infection had been treated using DAAs by the end of 2017. 

The scaling up of hepatitis testing and treatment will require comprehensive service delivery models that include (1) simple and standardized algorithms across the continuum of care; (2) integration of hepatitis testing, care and treatment with other related services; (3) strategies to strengthen linkage from testing to care, treatment and prevention; (4) decentralized services, supported by task-sharing/shifting; (5) community engagement and peer support to address stigma and discrimination, and reach vulnerable or disadvantaged communities; (6) efficient procurement and supply management of medicines and diagnostics; (7) data systems to monitor the quality of individual care and the cascade of care.

WHO guidelines on treatment have been available since 2014 for HCV infection (with updates in 2016 and 2018; the latter recommended treatment for all people living with HCV infection - except pregnant women - regardless of age, risk group or disease stage) and 2015 for HBV infection. WHO guidance and policy briefs are also available for the treatment and care of HIV-co-infected persons and priority populations including in people who inject drugs and prisoners.