Wong Grace Lai-Hung, Lemoine Maud
Medical Data Analytics Centre, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China; State Key Laboratory of Digestive Disease, Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, China.
Department of metabolism Digestion and Reproduction, Division of Digestive Diseases, St Mary's Hospital, Liver Unit, Imperial College London, UK; Medical Research Council @ the London School of Hygiene and Tropical Medicine The Gambia Unit, Fajara, The Gambia.
J Hepatol. 2025 May;82(5):918-925. doi: 10.1016/j.jhep.2024.12.004. Epub 2024 Dec 6.
Progress towards global elimination of hepatitis B virus (HBV) has been slow and most countries are far from reaching the elimination targets set out by the World Health Organization (WHO). The burden of chronic hepatitis B is mainly borne by resource-limited countries where only a minority of people living with HBV are diagnosed and treated, and international guidelines are hardly applicable in real-life. In March 2024, the WHO released its revised guidelines for the prevention and management of chronic hepatitis B. Simplification of care and expansion of treatment criteria represent the core of this revision. Whether and how these updated WHO guidelines will influence the next hepatitis B recommendations from the international liver societies (EASL, AASLD and APASL) remain uncertain. Yet, the European, American and Asian regions encompass multiple low, middle and intermediate-income countries with high HBV endemicity and vulnerable populations that should benefit from simplified clinical algorithms. Here, from an analysis of the WHO guideline development process and its new recommendations, we aimed to identify the anticipated areas of agreement and controversies with the next liver society hepatitis B guidelines, which will have to balance clinical risks and benefits for patients.
全球消除乙型肝炎病毒（HBV）的进展一直缓慢，大多数国家远未达到世界卫生组织（WHO）设定的消除目标。慢性乙型肝炎的负担主要由资源有限的国家承担，在这些国家，只有少数HBV感染者得到诊断和治疗，国际指南在现实生活中几乎无法适用。2024年3月，WHO发布了慢性乙型肝炎预防和管理的修订指南。简化护理和扩大治疗标准是此次修订的核心。这些更新后的WHO指南是否以及如何影响国际肝病学会（欧洲肝脏研究学会、美国肝病研究学会和亚太肝病学会）的下一轮乙型肝炎建议仍不确定。然而，欧洲、美洲和亚洲地区包括多个HBV高流行率的低收入、中等收入和中等偏上收入国家以及弱势群体，他们应该会从简化的临床算法中受益。在此，通过对WHO指南制定过程及其新建议的分析，我们旨在确定与下一轮肝病学会乙型肝炎指南预期达成一致和存在争议的领域，而下一轮指南将必须平衡患者的临床风险和益处。
