WHO 2024 Hepatitis B Guidelines: No more gray zone for low- and middle-income countries? An evaluation

The World Health Organization (WHO) has established targets to reduce the incidence rates of viral hepatitis by 90% and the death rate by 65% by 2030. However, despite global efforts, a substantial treatment gap persists, with merely 3% of eligible patients worldwide receiving antiviral therapy as of 2022. With more than 254 million people living with chronic HBV infection and approximately 1.1 million related deaths annually, the updated 2024 WHO guidelines significantly expand treatment eligibility to help achieve this objective. This review discusses how the new changes would benefit gray zone patients, particularly those in low- and middle-income countries (LMICs) who were historically excluded from therapy. By introducing age-based thresholds, incorporating non-invasive grading methods, and persistent ALT elevation to the treatment network, the 2024 guidelines promise broader inclusion. This review highlights the significance of these changes and evaluates the potential impact on the gray zone patients in resource-limited settings.