On 9 April, the World Health Organization (WHO) issued its first guidance for the treatment of hepatitis C. These guidelines were released on the eve of the opening of the 2014 International Liver Congress, that will be attended by nearly 10 000 delegates in London.
Hepatitis is a significant global concern due to the vast burden of illness, death and the potential for outbreaks and epidemic spread. Approximately 150 million people around the world have been infected with the hepatitis C virus (HCV), causing 350 000 to 500 000 deaths a year.
“The WHO recommendations are based on a thorough review of the best and latest scientific evidence,” says Dr Stefan Wiktor, who leads WHO’s Global Hepatitis Programme. “The new guidance aims to help countries to improve treatment and care for hepatitis and thereby reduce deaths from liver cancer and cirrhosis.”
Despite the high prevalence, most people infected are unaware of their infection. Hepatitis C is commonly transmitted through exposure to infected blood. Chronic hepatitis C suffers often experience fatigue, a diminished appetite, joint and muscle pain as well as yellowing of the skin and eyes, urine of a dark yellow colour and an increased tendency to bleed or bruise.
Hepatitis C virus infection is closely associated with unsafe injection practices and procedures such as renal (kidney) dialysis and unscreened blood transfusions.
According to the new “Guidelines for the screening, care and treatment of persons with hepatitis C infection”, between 8 and 12 billion injections are administered yearly around the world and 50% of these are considered to be unsafe (mainly in sub-Saharan Africa and Asia).
Blood safety is a significant concern and according to the latest WHO report on blood safety, “39 countries do not routinely screen blood transfusions for bloodborne viruses. The most well documented example of health care associated transmission is the generalized epidemic of HCV infection resulting from unsafe injection practices in Egypt, where HCV prevalence is 25% in some regions.”
“Today’s launch highlights the need for more awareness and education on hepatitis for the general public. Greater awareness on the risks associated with hepatitis C should lead to a demand for services and expansion of laboratory capacity and clinical services so that more people can be tested, treated and cured,” says Dr Andrew Ball, Senior Advisor for Policy, Strategy and Equity for WHO’s HIV/AIDS Department where the Global Hepatitis Programme is housed.
Groups at increased risk of hepatitis C, especially people who have received unscreened blood products, are also at risk of infection with tuberculosis (TB). TB is the leading cause of HIV-associated illness and mortality.
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 4 to 8% among mothers without HIV infection and 17 to 25% among mothers with HIV infection.
Another important co-infection is with hepatitis B. This co-infection is commonly found in hepatitis B endemic countries in Asia, sub-Saharan Africa and South America. In some areas, up to 25% of hepatitis C sufferers are co-infected with hepatitis B.
Hepatitis C infection differs from the other chronic viral infections – notably HIV – in that it can be cured by treatment. However, despite its treatability, treatment remains unavailable for many who have been diagnosed with hepatitis C.
“Hepatitis C treatment is currently unaffordable to most patients in need. The challenge now is to ensure that everyone who needs these drugs can access them,” says Dr Peter Beyer, Senior Advisor for the Essential Medicines and Health Products Department at WHO. “Experience has shown that a multi-pronged strategy is required to improve access to treatment, including creating demand for treatment. The development of WHO guidelines is a key step in this process.”
The new guidelines include recommendations on all medicines approved as of December 2013, and they will be updated periodically as new compounds become available.
Dr Couillard is an international health columnist that works in collaboration with the World Health Organization’s goals of disease prevention and control. Views do not necessarily reflect endorsement.
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