Guidelines on hepatitis B and C testing

Overview

Hepatitis B virus (HBV) and hepatitis C virus (HCV) infection are major causes of acute and chronic liver disease (e.g. cirrhosis and hepatocellular carcinoma) globally, and cause an estimated 1.4 million deaths annually. It is estimated that, at present, 248 million people are living with chronic HBV infection, and that 110 million persons are HCV-antibody positive, of which 80 million have active viraemic infection. The burden of chronic HBV and HCV remains disproportionately high in low- and middle-income countries (LMICs), particularly in Asia and Africa. Additionally, even in low-prevalence areas, certain populations have high levels of HCV and HBV infection, such as persons who inject drugs (PWID), men who have sex with men (MSM), people with HIV, as well as those belonging to certain indigenous communities.

The development of highly effective, well-tolerated oral direct acting antiviral (DAA) treatment regimens with high rates of cure after 8–12 weeks of treatment has revolutionized the treatment of chronic HCV infection, although the high prices of these new medicines remain a major barrier to access in many countries. Effective long-term antiviral treatment with tenofovir or entecavir is also available for people with chronic HBV infection. However, despite the high global burden of disease due to chronic HBV and HCV infection, and the advances and opportunities for treatment, most people infected with HBV and/ or HCV remain unaware of their infection and therefore frequently present with advanced disease and may transmit infection to others. There are several key reasons for this low rate of hepatitis testing. These include the limited facilities or services for hepatitis testing, lack of effective testing policies or national guidelines, complex diagnostic algorithms, and poor laboratory capacity and quality assurance systems.

Testing and diagnosis of hepatitis B and C infection is the gateway for access to both prevention and treatment services, and is a crucial component of an effective response to the hepatitis epidemic. Early identification of persons with chronic HBV or HCV infection enables them to receive the necessary care and treatment to prevent or delay progression of liver disease. Testing also provides an opportunity to link people to interventions to reduce transmission, through counselling on risk behaviours and provision of prevention commodities (such as sterile needles and syringes) and hepatitis B vaccination.