Treatment For Chronic Hepatitis B Infection
Most people diagnosed with chronic hepatitis B infection need treatment for the rest of their lives. Treatment helps reduce the risk of liver disease and prevents you from passing the infection to others. Treatment for chronic hepatitis B may include:
- Antiviral medications. Several antiviral medications including entecavir , tenofovir , lamivudine , adefovir and telbivudine can help fight the virus and slow its ability to damage your liver. These drugs are taken by mouth. Talk to your doctor about which medication might be right for you.
- Interferon injections. Interferon alfa-2b is a man-made version of a substance produced by the body to fight infection. It’s used mainly for young people with hepatitis B who wish to avoid long-term treatment or women who might want to get pregnant within a few years, after completing a finite course of therapy. Interferon should not be used during pregnancy. Side effects may include nausea, vomiting, difficulty breathing and depression.
- Liver transplant. If your liver has been severely damaged, a liver transplant may be an option. During a liver transplant, the surgeon removes your damaged liver and replaces it with a healthy liver. Most transplanted livers come from deceased donors, though a small number come from living donors who donate a portion of their livers.
Other drugs to treat hepatitis B are being developed.
What Treatments Are Available For Chronic Hepatitis B If Medications Dont Work
If you have advanced hepatitis B, you might also become a candidate for a liver transplant. This path does not always result in a cure because the virus continues in your bloodstream after a transplant. To prevent being infected again after your transplant, you may be prescribed hepatitis B immunoglobulin with an antiviral agent.
World Health Organization Recommendations
The 2015 WHO guidelines for the prevention, care, and treatment of persons with chronic hepatitis B infection indicates treatment priority for individuals of all ages who have chronic hepatitis B infection and clinical evidence of compensated/decompensated cirrhosis , regardless of their levels of ALT or HBV DNA, or their HBeAg status.
Treatment is recommended for adults with chronic hepatitis B infection without clinical evidence of cirrhosis , but who have all of the following features , and regardless of HBeAg status :
- Are older than 30 years
- Have persistently abnormal ALT levels
- Have evidence of high-level HBV replication .
In individuals with HBV/human immunodeficiency virus coinfection, the AASLD recommends initiating ART in all those with evidence of severe chronic liver disease, regardless of CD4 count, as well as those with a CD4 count of 500 cells/mm3 or below, regardless of their liver disease stage.
However, the AASLD does not recommend antiviral therapy, indicating it can be deferred, in individuals with all of the following , regardless of HBeAg status or age :
- No clinical evidence of cirrhosis
- Persistently normal ALT levels
- Low levels of HBV DNA replication . ]
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How Common Is Hepatitis B
The number of people who get this disease is down, the CDC says. Rates have dropped from an average of 200,000 per year in the 1980s to around 20,000 in 2016. People between the ages of 20 and 49 are most likely to get it.
About 90% of infants and 25-50% of children between the ages of 1-5 will become chronically infected. In adults, approximately 95% will recover completely and will not go on to have a chronic infection.
As many as 1.2 million people in the U.S. are carriers of the virus.
How Can I Prevent Spreading Hepatitis B To Others
If you have hepatitis B, follow the steps above to avoid spreading the infection. Your sex partners should get a hepatitis B test and, if they arent infected, get the hepatitis B vaccine. You can protect others from getting infected by telling your doctor, dentist, and other health care professionals that you have hepatitis B. Dont donate blood or blood products, semen, organs, or tissue.
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Who Is At Risk For Hepatitis B
Anyone can get hepatitis B, but the risk is higher in:
- Infants born to mothers who have hepatitis B
- People who inject drugs or share needles, syringes, and other types of drug equipment
- Sex partners of people with hepatitis B, especially if they are not using latex or polyurethane condoms during sex
- Men who have sex with men
- People who live with someone who has hepatitis B, especially if they use the same razor, toothbrush, or nail clippers
- Health care and public-safety workers who are exposed to blood on the job
- Abdominal pain
- Yellowish eyes and skin, called jaundice
If you have chronic hepatitis B, you may not have symptoms until complications develop. This could be decades after you were infected. For this reason, hepatitis B screening is important, even if you have no symptoms. Screening means that you are tested for a disease even though you don’t have symptoms. If you are at high risk, your health care provider may suggest screening.
What Should You Know About Hepatitis B Before You Travel
Hepatitis B is quite common in China and other Asian countries, where as many as 1 in 12 people have the virus, though many dont know it. Before traveling to those places, you should make sure youve been vaccinated against the virus.
In addition to getting the vaccine, you can take these additional precautions to reduce your risk of contracting the virus:
- Refrain from taking illegal drugs.
- Always use latex or polyurethane condoms during sex.
- Make sure new, sterile needles are used during all piercings, tattoos and acupuncture sessions.
- Avoid direct contact with blood and bodily fluids.
- Know the HBV status of all your sexual partners.
- Ask your doctor about possible vaccination before you travel to a place where hepatitis B is common.
A note from Cleveland Clinic
Hepatitis B is a liver disease that can cause serious damage to your health. One reason that is dangerous is that it can easily go undetected for years while damaging your liver. Talk with your healthcare provider about being tested for hepatitis B if you have any reason to believe that you were not vaccinated or if you have engaged in risky behavior. If you do test positive, follow the directions from your healthcare provider so that you can live a longer, healthier and happier life.
Last reviewed by a Cleveland Clinic medical professional on 07/09/2020.
References
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What Other Problems Can Hepatitis B Cause
In rare cases, acute hepatitis B can cause liver failure.
Chronic hepatitis B can develop into a serious disease that causes long-term health problems such as cirrhosis , liver cancer, and liver failure.
If you have ever had hepatitis B, the virus may become active again, or reactivated, later in life. This could start to damage the liver and cause symptoms.
Hepatitis B Vs Hepatitis C
Hepatitis has many different types. HBV and the hepatitis C virus have both acute and chronic forms.
The main difference between HBV and HCV is how they spread from person to person. Although HCV is transmissible via sexual activity, this is rare. HCV usually spreads when blood that carries the virus comes into contact with blood that does not.
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American Association For The Study Of Liver Diseases Recommendations
The 2016 AASLD guidelines for the treatment of chronic hepatitis B as well as select recommendations from the 2018 AASLD guidance update on the prevention, diagnosis, and treatment of chronic hepatitis B are outlined below and in the Guidelines section.
Adults with immune-active chronic hepatitis B infection
Administer antiviral therapy to lower the risk of morbidity and mortality associated with chronic hepatitis B infection.
The recommended initial agent for adults is PEG-IFN, entecavir, or tenofovir.
Adults with immune-tolerant chronic hepatitis B infection
Antiviral therapy is not recommended.
The AASLD suggests obtaining ALT levels at least every 6 months to monitor for potential transition to immune-active or -inactive chronic hepatitis B.
For select patients older than 40 years, the AASLD suggests antiviral therapy in the setting of normal ALT levels, elevated HBV DNA , and significant necroinflammation or fibrosis on liver biopsy specimens.
Adults with HBeAg-positive immune-active chronic hepatitis B who seroconvert to anti-HBe on nucleoside analog therapy
After a period of treatment consolidation , consider discontinuing NA therapy in noncirrhotic HBeAg-positive adults who seroconvert to anti-HBe while on NA treatment. If antiviral therapy is stopped, monitor the patient every 3 months for a minimum of 1 year for recurrent viremia, ALT flares, seroreversion, and clinical decompensation.
Adults with HBeAg-negative immune-active chronic HBV infection
Inpatient care
Change In The Terminology Of Hbv Carriers
HBV infection is termed as chronic if it continues to be HBsAg +ve for 6 months. Chronic HBV infection is a dynamic process with a wide spectrum of spectrum of affliction. On one hand patients are asymptomatic with no clinical evidence of liver diseases, while on other being end-stage cirrhosis and hepatocellular carcinoma. For many decades the patients were considered to have a benign, non progression infection and were designated as hepatitis B “carriers”. Probably the word ‘carrier’ was mistakenly chosen for hepatitis B as in true sense, a carrier is an individual who harbors a specific infectious agent has no discernible clinical disease and serves as a potential source of infection. For this infection the second and third points should be looked at carefully. One the basis of Asian collaborative survey the term ‘carrier’ was replaced by the term ‘chronic hepatitis B virus infection’ . Later on for this infection the term ‘Inactive HBsAg carrier’ was adopted .
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Treatment Options For Hepatitis B
People living with chronic hepatitis B infection should expect to live a long and healthy life. There are decisions people can make to protect their livers such as seeing a liver specialist or health care provider regularly, avoiding alcohol and tobacco, and eating healthy foods. There are also approved drugs for both adults and children that control the hepatitis B virus, which helps reduce the risk of developing more serious liver disease, but there is still no complete cure.
Current treatments for hepatitis B fall into two general categories:
- Immune modulator Drugs These are interferon-type drugs that boost the immune system to help get rid of the hepatitis B virus. They are given as a shot over 6 months to 1 year.
- Antiviral Drugs These are drugs that stop or slow down the hepatitis B virus from reproducing, which reduces the inflammation and damage of your liver. These are taken as a pill once a day for at least 1 year and usually longer.
It is important to know that not everyone with chronic hepatitis B infection needs to be treated. This can be difficult to accept when first diagnosed because taking a drug to get rid of the virus seems like the first step to getting better. Current treatments, however, are generally found to be most effective in those who show signs of active liver disease .
Hepatitis B Drug Watch
Visit the HBF Drug Watch for a complete list of the approved treatments for hepatitis B and promising new drugs in development.
What To Expect From Your Doctor
Your doctor is likely to ask you a number of questions, including:
- When did your symptoms begin?
- Have your symptoms been continuous or occasional?
- How severe are your symptoms?
- What, if anything, seems to improve your symptoms?
- What, if anything, appears to worsen your symptoms?
- Have you ever had a blood transfusion?
- Do you inject drugs?
- Have you had unprotected sex?
- How many sexual partners have you had?
- Have you been diagnosed with hepatitis?
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Acute Hepatitis B Symptoms
There are three phases of acute hepatitis B infection, and symptoms may differ depending on the stage. Early in the disease, called the prodromal phase, symptoms may include:
- Fever
- Dark urine and light stool color
During the icteric phase:
- Jaundice develops
- Anorexia, nausea and vomiting may worsen
- Irritated skin lesions may develop
- Other symptoms may subside
For How Long Is A Person Able To Spread The Virus
The virus can be found in blood and other body fluids several weeks before symptoms appear and generally persists for several months afterward. Approximately 10 percent of infected adults may become long-term carriers of the virus. Infants infected at birth have a 90 percent chance of becoming chronically infected.
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What Determines Whether A Patient With Chronic Hepatitis B Needs Treatment
Hepatitis B drugs are recommended for patients with very active virus and an inflamed liver. These patients will have a very high amount of hepatitis B virus in their blood and an unusually high level of a chemical known as ALT, which is one of the “liver enzymes” that helps the liver do its work. People with cirrhosis also may be candidates for treatment.
Over time, patients can go through different phases with their hepatitis B. A patient can have a low amount of virus and normal level of ALT for many years, prolonged periods of high viral loads and ALT levels, or short bursts of high viral activity that later subside. It is important to use hepatitis B treatments during phases of high viral activity and prolonged liver inflammation. Your provider will track the phase of hepatitis B by the results of blood tests. So, it is recommended that people with hepatitis B have blood tests on a regular basis.
For the small percentage of patients who have chronic hepatitis B and also have chronic hepatitis C, when it comes time to be treated with medication for the hepatitis C virus, the hepatitis C medications can cause the hepatitis B virus to flare. In order to prevent this from happening, these patients will need to take hepatitis B treatment at the same time that they take the hepatitis C virus medications.
How Is Hepatitis B Treated
Your healthcare provider will treat you based on what type of hepatitis B you have, acute or chronic.
Acute hepatitis B infections
If you develop an acute form of the condition, you probably wont need medical treatment. Instead, your doctor will likely suggest that you get plenty of rest, drink lots of fluids and maintain a healthy diet to support your body as it fights off the infection.
Chronic hepatitis B infections
If you have chronic hepatitis B, you might be a candidate for drug therapy. Usually, drug therapy is used only if you have active liver disease. There are seven drugs that are approved by the U.S. Food and Drug Administration to treat hepatitis B. Two are injectable forms of interferon, while the five other antivirals are tablets.
You will need to take these medications every day. They help by slowing the viruss ability to multiply in your system. This helps reduce swelling and liver damage. Youll need to be regularly monitored for early signs of liver damage and liver cancer. Your healthcare provider will want to see you once or twice a year.
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Prevent Hepatitis B Infections In Newborns
If you are pregnant and have hepatitis B, talk with your doctor about lowering the risk that the infection will spread to your baby. Your doctor will check your virus levels during pregnancy. If virus levels are high, your doctor may recommend treatment during pregnancy to lower virus levels and reduce the chance that hepatitis B will spread to your baby. Your doctor may refer you to a liver specialist to find out if you need hepatitis B treatment and to check for liver damage.
When it is time to give birth, tell the doctor and staff who deliver your baby that you have hepatitis B. A health care professional should give your baby the hepatitis B vaccine and HBIG right after birth. The vaccine and HBIG will greatly reduce the chance of your baby getting the infection.
Antiviral Medication For Hepatitis C
For people with hepatitis C, the goal of treatment with antiviral medication is to prevent the virus from replicating, or copying itself, and to eliminate the virus from the bloodstream. If the hepatitis C virus has been in the body for more than six months, the infection is considered chronic. Without treatment, most people with acute hepatitis C develop the chronic form of the disease.
Your doctor decides which antiviral medicationor combination of medicationsto prescribe based on the results of a blood test called a genotype test. There are six genotypes, or strains, of the hepatitis C virus, and people with certain genotypes respond more quickly to medical treatment.
For many years, the standard treatment for chronic hepatitis C consisted of the antiviral medications pegylated interferon and ribavirin. Ribavirin is taken by mouth every day, and interferon is an injection that you or a caregiver can administer once a week at home.
In 2013 and 2014, the U.S. Food and Drug Administration approved a group of new medications for the treatment of hepatitis C. These medications, which include sofosbuvir, are very effective and have fewer side effects than older medications, particularly interferon.
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When Can Hepatitis B Patients Stop Taking Antivirals Experts Finally Have Some Answers
With the help of antivirals, many patients today have undetectable viral load , a relatively healthy liver and cleared the hepatitis B e antigen . So when can they consider stopping their daily entecavir or tenofovir pill?
For years, experts have admitted the endgame of antiviral treatment has been ill-defined. While antivirals reduce viral load and the risk of liver damage, they rarely cure people. Recently, after years of observing patients and with the help of better diagnostic tools, experts are getting better at identifying when might be safe to stop.
Historically, in addition to reducing viral load to undetectable levels, the goals of antiviral treatment were:
- Triggering HBeAg seroconversion: About 21 percent of HBeAg-positive patients with liver damage treated with either tenofovir or entecavir for 12 months are able to lose the hepatitis B e antigen and develop the e antibody . This HBeAg seroconversion indicates the immune system is fighting the infection and slowing viral replication.
- And reducing liver damage and even clearing the hepatitis B surface antigen : About 1-3 percent of patients treated with antivirals lose HBsAg after years of treatment. This is called a functional cure. Unfortunately, if you have HBeAg-negative hepatitis B, only 1-2 percent of you will lose HBsAg after five to eight years of antiviral treatment.*