title: Treatment of chronic hepatitis B virus infection in resource-constrained settings: expert panel consensus.
abstract: Most of the estimated 350 million people with chronic hepatitis B virus (HBV) infection 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. Antiviral agents active against HBV are available; 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 could benefit from treatment. However, drugs active against HBV 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, which is of great concern for the estimated 10% of the HIV-infected persons in Africa who are co-infected with HBV. Progressive liver disease has been shown to occur in co-infected persons whose HBV infection is not suppressed. In view of these concerns, an informal World Health Organization consultation of experts concluded that: chronic HBV is a major public health problem in emerging nations; all HIV-infected persons should be screened for HBV infection; HIV/HBV co-infected persons should be treated with therapies 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 was developed focusing on issues related to prevention and treatment of chronic HBV in resource-constrained settings.
authors.affiliation: World Health Organization, FCH/IVB, Geneva, Switzerland. wiermas@who.int
authors.forename: Steven T
authors.initials: ST
authors.lastname: Wiersma
authors.forename: Brian
authors.initials: B
authors.lastname: McMahon
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Pawlotsky
authors.forename: Chloe L
authors.initials: CL
authors.lastname: Thio
authors.forename: Mark
authors.initials: M
authors.lastname: Thursz
authors.forename: Seng Gee
authors.initials: SG
authors.lastname: Lim
authors.forename: Ponsiano
authors.initials: P
authors.lastname: Ocama
authors.forename: Gamal
authors.initials: G
authors.lastname: Esmat
authors.forename: Maimuna
authors.initials: M
authors.lastname: Mendy
authors.forename: Mendy
authors.initials: M
authors.lastname: Maimuna
authors.forename: David
authors.initials: D
authors.lastname: Bell
authors.forename: Marco
authors.initials: M
authors.lastname: Vitoria
authors.forename: Irina
authors.initials: I
authors.lastname: Eramova
authors.forename: Daniel
authors.initials: D
authors.lastname: Lavanchy
authors.forename: Geoff
authors.initials: G
authors.lastname: Dusheiko
mesh_terms: D000998:Antiviral Agents / Q000191:economics* / Q000627:therapeutic use*; D003906:Developing Countries / Q000191:economics*; D016527:Drug Costs; D006295:Health Resources / Q000191:economics* / Q000600:supply & distribution; D006297:Health Services Accessibility / Q000191:economics; D054625:Healthcare Disparities / Q000191:economics; D017325:Hepatitis B Vaccines / Q000191:economics*; D019694:Hepatitis B, Chronic / Q000175:diagnosis / Q000188:drug therapy* / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control; D006801:Humans; D017589:Immunization Programs / Q000191:economics; D016896:Treatment Outcome; D014944:World Health Organization
chemical_list: D000998:Antiviral Agents; D017325:Hepatitis B Vaccines