The 2024 updated WHO guidelines for the prevention and management of chronic hepatitis B: main changes and potential implications for the next major liver society clinical practice guidelines

Abstract

Progress towards hepatitis B virus (HBV) global elimination has been slow and most countries are far to reach the elimination targets set up by the World Health Organization (WHO). The burden of chronic hepatitis B is mainly bear by resource-limited countries where only a minority of people living with HBV are diagnosed and treated and international guidelines 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 international liver societies (EASL, AASLD and APASL) for their next hepatitis B recommendations 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 agreements and controversies with the next liver society hepatitis B guidelines which will have to balance clinical risks and benefits for the patients.