World Health Organization, FCH/IVB, Geneva, Switzerland Alaska Native Medical Center, CDC Arctic Investigations Program, Anchorage, AK, USA Department of Virology, Hopital Henri Mondor, Paris, France Department of Medicine, Johns Hopkins University, Baltimore, MD, USA Department of Academic Medicine, St Mary's Hospital Campus, Imperial College, London, UK Department of Medicine, National University Hospital, Singapore, Singapore Department of Medicine, Makerere University, Mulago Hospital, Kampala, Uganda Faculty of Medicine, Cairo University, Cairo, Egypt Medical Research Council Laboratory, Banjul, The Gambia US Centers for Disease Control and Prevention, Division of Viral Hepatitis, Atlanta, USA World Health Organization, HIV/AIDS, Geneva, Switzerland World Health Organization, EURO, Copenhagen, Denmark World Health Organization, HSE, Geneva, Switzerland Royal Free Hospital, School of Medicine, London, UK.
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.