The World Health Organization (WHO) has issued its first-ever guidance for the treatment of chronic Hepatitis B.

Hepatitis B is a viral infection which 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.

A statement issued by the WHO on Saturday said, worldwide, some 240 million people have chronic Hepatitis B virus with the highest rates of infection in Africa and Asia. It said people with chronic Hepatitis B infection were at increased risk of dying from cirrhosis and liver cancer.

“Effective medicines exist that can prevent people developing these conditions so they live longer. But most people who need these medicines are unable to access them or can only obtain substandard treatment,” the statement said.

The statement noted that one reason for this, is the lack of clear evidence-based guidance for countries; especially low- and middle-income countries, as to who should be treated, and what medicines to use.

“Deciding who needs treatment for hepatitis B depends on a number of factors,” said Dr Stefan Wiktor, who leads WHO’s Global Hepatitis Programme. “These new guidelines, which give treatment recommendations that rely on simple, inexpensive tests, will help clinicians make the right decisions.”

The “WHO guidelines for the prevention, care and treatment of persons living with chronic Hepatitis B infection” lay out a simplified approach to the care of people living with chronic hepatitis B, particularly in settings with limited resources.

The guidance covers the full spectrum of care from determining who needs treatment, to what medicines to use, and how to monitor people long-term.

It recommends the use of a few simple non-invasive tests to assess the stage of liver disease to help identify who needs treatment and prioritising treatment for those with cirrhosis – the most advanced stage of liver disease.

The guidelines also recommends the use of two safe and highly effective medicines, tenofovir or entecavir, for the treatment of chronic hepatitis B and regular monitoring using simple tests for early detection of liver cancer, to assess whether treatment is working, and if treatment can be stopped.

The special needs of specific populations, such as people co-infected with HIV, as well as children and adolescents, and pregnant women are also considered.

It said the two recommended medicines were already available in many countries as generics, and thus were relatively inexpensive, costing as little as five dollars per person per month.

“Because for so many people treatments is life-long it is important that patients can access these medicines at the lowest possible price,” said Dr. Wiktor.

According to it, a number of countries are beginning to develop hepatitis B treatment programmes, and the newly-released document also provide guidance on how to organise hepatitis care and treatment services.

“For example, countries need to think about ways to improve access to medicines and how best to deliver quality care, that builds on existing health services and staff,” said Dr Philippa Easterbrook, from the WHO Global Hepatitis Programme.

The guidelines indicated that treatment could prolong life for people already infected with hepatitis B, but it was also important to focus on preventing new infections.

WHO recommends that all children are vaccinated against Hepatitis B, with a first dose given at birth.

It said some countries, particularly in Asia, had reduced the rates of childhood hepatitis B infection through universal childhood vaccination.

It said the challenge now is to scale up efforts to ensure that all children worldwide are protected from the virus.

It noted that another route of infection is through the reuse of medical equipment, in particular of syringes.

WHO has recently launched a new policy on injection safety that will also help prevent new hepatitis B infections.

The policy calls for the worldwide use of “smart” syringes to prevent the re-use of syringes or needles.

The new guidelines on treating Hepatitis B follow from the publication last year by WHO of its first-ever guidelines on treating Hepatitis C.