Background

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. (WHO, 2017)