The World Health Organization (WHO) has issued its first guidance for the treatment of hepatitis C,
a chronic infection that affects an estimated 130 million to 150
million people and results in 350 000 to 500 000 deaths a year.
According to WHO, the publication of the "WHO Guidelines for the screening, care
and treatment of persons with hepatitis C infection" coincides with the
availability of more effective and safer oral hepatitis medicines,
along with the promise of even more new medicines in the next few years.
“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.”
The global health body said it will be working with countries to introduce the guidelines
as part of their national treatment programmes. WHO support will
include assistance to make the new treatments available and
consideration of all possible avenues to make them affordable for all.
WHO will also assess the quality of hepatitis laboratory tests and
generic forms of hepatitis medicines.
“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 make nine key recommendations. These
include approaches to increase the number of people screened for
hepatitis C infection, advice as to how to mitigate liver damage for
those who are infected and how to select and provide appropriate
treatments for chronic hepatitis C infection.
Screening
WHO recommends a screening test for those considered at high
risk of infection, followed by another test for those who screen
positive, to establish whether they have chronic hepatitis C infection.
Mitigating liver damage
Since alcohol use can accelerate liver damage caused by
hepatitis C, WHO now advises that people with chronic hepatitis C
infection receive an alcohol assessment. The Organization also
recommends providing counseling to reduce alcohol intake for people with
moderate or high alcohol use. In addition, the guidelines provide
advice on the selection of the most appropriate test to assess the
degree of liver damage in those with chronic hepatitis C infection.
Treatment
The guidelines provide recommendations on existing treatments
based on interferon injections as well as the new regimens that use only
oral medicines. WHO will update recommendations on drug treatments
periodically as additional antiviral medicines are registered on the
market and new evidence emerges.
Prevention
The 2014 recommendations also summarize for policy makers and
health care workers interventions that should be put in place to prevent
transmission of hepatitis C, including measures to assure the safety of
medical procedures and injections in health care settings and among
persons who inject drugs. Rates of new hepatitis C infections remain
unacceptably high in many countries because of the reuse of injection
equipment and lack of screening of blood transfusions.
“Many people remain unaware - sometimes for decades - that
they are infected with hepatitis C,” says Dr Andrew Ball, Senior Advisor
for Policy, Strategy and Equity for WHO’s HIV/AIDS Department where the
Global Hepatitis Programme is housed. “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.”
There are five main hepatitis viruses, referred to as types A,
B, C, D and E. Hepatitis B and C have the greatest public health impact
because they cause chronic infection which can progress to cirrhosis
and liver cancer. Hepatitis A and E, spread though unsafe water and
contaminated food, have the potential to cause outbreaks in certain
populations.
Hepatitis C virus is most commonly transmitted through
exposure to contaminated blood. Those at risk include people undergoing
invasive medical procedures and therapeutic injections where there is
poor infection control. Also at risk are those exposed to contaminated
injecting and skin piercing equipment, including through injecting drug
use, tattooing and body piercing.
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