Injections: Interferon And Pegylated Interferon
Pegylated interferon is FDA-approved for HBV treatment. It is given as an injection once per week. It can be used alone or with an oral hepatitis B medication. Patients with both chronic hepatitis B and hepatitis D infection may need pegylated interferon alone or combined with an oral hepatitis B pill.
- Pegylated interferon therapy is usually given for 48 weeks.
- Pegylated interferon may cause many side effects, such as flu-like symptoms, rashes, irritability, and depression.
Selection Of Patients For Treatment
The persistence of HBV despite treatment often necessitates long durations of therapy. Therefore, the decision to treat must balance the risk of liver-related morbidity and mortality in the future with the likelihood of sustained response to treatment. The development of antiviral resistance is a major obstacle in long-term viral suppression hence, therapy should be initiated only when the benefits outweigh the risks.
Initial evaluation of HBV carriers should include assessment of HBV replication: HBeAg and HBe antibody , and quantitative HBV DNA level and activity/stage of liver disease: ALT, indicators of liver synthetic function , and evidence of portal hypertension . A liver biopsy is the only reliable method to assess histological damage, but is not necessary in all cases. High risk carriers should also be screened for HCC.
Figure 1
Modified American Association for the Study of Liver Disease algorithm for treatment of non-cirrhotic hepatitis B. ULN, upper limit of normal IFN, interferon-alfa LAM, lamivudine ADV, adefovir ETV, entecavir NA, nucleoside analogues PCR, polymerase chain reaction wks, weeks mos, months. In patients who meet only a single criterion, optimal management is not clear liver biopsy may be useful in defining histological necroinflammatory activity.
Screening for HCC is indicated for patients who have cirrhosis, men over the age of 40 and women over the age of 50, and those with a family history of HCC.
Improving The Hbsag Clearance Rate By Optimizing Antiviral Treatment
Previous studies concluded that HBsAg level is a marker for determining the safety of drug withdrawal after patients achieve HBeAg seroconversion. It was generally believed that drugs can be withdrawn safely from patients with HBsAg < 1000 IU/mL. Liu et al systematically reviewed 11 studies comprising 1716 patients, aiming to determine the effects of HBsAg level on NA withdrawal in Asian CHB patients. The study found that among patients with HBsAg < 100 IU/mL, after more than 1 year of drug withdrawal and follow-up, 9.1%-19.6% of patients had virologic relapse , and 15.4%-29.4% patients had clinical relapse . The results indicated that although HBsAg is very low in patients undergoing NA treatment, the relapse rate after drug withdrawal is still high. However, if patients with low levels of HBsAg were treated properly, they could achieve HBsAg clearance. Therefore, the goal of antiviral treatment should not be limited to lack of relapse after drug withdrawal. HBsAg clearance is the most effective way to reduce relapse and improve prognosis.
Pattern of different antiviral treatment regimens. IFN: Interferon NA: Nucleoside analogue.
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Hepatitis B Treatment Outcomes
Effective hepatitis B treatment suppresses hepatitis B virus reproduction, and reducing hepatitis B viral load can reduce inflammation and bring liver enzyme levels back to normal. Less often, treatment can lead to loss of hepatitis B antigens and promote production of antibodies .
The most effective antiviral drugs usually produce low or undetectable hepatitis B viral load in most people who receive treatment. However, people with HBeAg-negative hepatitis B are more likely to respond to treatment. For example, one study found that among HIV-negative people treated with tenofovir, around 95% of HBeAg-negative people and 75% of HBeAg-positive people had undetectable hepatitis B virus DNA after one year. A majority of both groups still had hepatitis B suppression after eight years on treatment.
Most people taking antivirals alone do not experience hepatitis B antigen loss or seroconversion. Pegylated interferon strengthens the immune response against hepatitis B, but usually does not lead to a cure. Some studies show that adding pegylated interferon to antivirals increases the likelihood of these outcomes. For people with co-infection, seroconversion appears to be more likely if they are also on HIV treatment.
There is currently no treatment that cures a majority of people with hepatitis B. Researchers are working on new types of treatment including direct-acting antivirals that attack different steps of the hepatitis B lifecycle and drugs that improve immune response.
Helpful Tips While Taking Hepatitis C Medications
- Always follow your health care providers’ advice, particularly the instructions on taking your medicine.
- If you have to cancel an appointment, call your provider and schedule a new one as soon as possible.
- Take good care of yourself. Eat well, drink 8 to 10 glasses of water each day, and try to get a full night’s sleep.
- Learn about the hepatitis C medications you are taking. This includes special risks and warnings.
- If taking ribavirin, use sunscreen, wear long sleeves and a hat, and limit sun exposure.
- Write down your doctor’s name and phone number. Carry this information with you at all times.
- Write the names and amounts of the medicines you are taking. Carry this information with you at all times.
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Treatment For Acute Hepatitis B
If you’re diagnosed with hepatitis B, your GP will usually refer you to a specialist, such as a hepatologist .
Many people do not have any troublesome symptoms, but if you do feel unwell, it can help to:
- get plenty of rest
- take over-the-counter painkillers, such as paracetamol or ibuprofen, for tummy pain
- maintain a cool, well-ventilated environment, wear loose clothing, and avoid hot baths or showers if itching is a problem
- take medication, such as metoclopramide, to stop you feeling sick, and chlorphenamine to reduce itching your doctor can give you a prescription for these if necessary
Most people recover completely in a couple of months, but you’ll be advised to have regular blood tests to check that you’re free of the virus and have not developed chronic hepatitis B.
What Other Drugs Will Affect Viread
Sometimes it is not safe to use certain medications at the same time. Some drugs can affect your blood levels of other drugs you take, which may increase side effects or make the medications less effective.
Tenofovir can harm your kidneys, especially if you also use certain medicines for infections, cancer, osteoporosis, organ transplant rejection, bowel disorders, high blood pressure, or pain or arthritis .
Many drugs can interact with tenofovir. This includes prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible interactions are listed here. Tell your doctor about all your current medicines and any medicine you start or stop using.
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Question 2 Effectiveness Of Antiviral Therapy In Patients With Immune
Two studies, evaluated antiviral therapy in HBeAg-positive patients with normal ALT levels. Detailed study characteristics and risk of bias are described in Tables and .
One RCT compared tenofovir to a combination of tenofovir and emtricitabine for 192 weeks. Although no long-term clinical outcomes were reported, tenofovir and emtricitabine versus tenofovir showed a statistically significant increase in viral suppression but no statistically significant increase in HBeAg loss , HBeAg seroconversion , or HBsAg clearance . The quality of evidence was low due to indirectness and imprecision.
In a cohort study of 68 HBeAg-positive postpartum women, pegylated IFN and adefovir versus untreated control significantly improved rates of HBeAg seroconversion and HBeAg loss . The quality of evidence was very low, down-rated due to the observational nature of the study, risk of bias, and imprecision.
How Is Viral Hepatitis Diagnosed
Diagnosis of viral hepatitis is based on symptoms and physical findings as well as blood tests for liver enzymes, viral antibodies, and viral genetic materials.
Symptoms and physical findings
Diagnosis of acute viral hepatitis often is easy, but the diagnosis of chronic hepatitis can be difficult. When a patient reports symptoms of fatigue, nausea, abdominal pain, darkening of urine, and then develops jaundice, the diagnosis of acute viral hepatitis is likely and can be confirmed by blood tests. On the other hand, patients with chronic hepatitis due to HBV and HCV often have no symptoms or only mild nonspecific symptoms such as chronic fatigue. Typically, these patients do not have jaundice until the liver damage is far advanced. Therefore, these patients can remain undiagnosed for years to decades.
Blood tests
There are three types of blood tests for evaluating patients with hepatitis: liver enzymes, antibodies to the hepatitis viruses, and viral proteins or genetic material .
Liver enzymes: Among the most sensitive and widely used blood tests for evaluating patients with hepatitis are liver enzymes, called aminotransferases. They include aspartate aminotransferase and alanine aminotransferase . These enzymes normally are contained within liver cells. If the liver is injured , the liver cells spill the enzymes into the blood, raising the enzyme levels in the blood and signaling that the liver is damaged.
Examples of tests for viral antibodies are:
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Question 4 Stopping Compared To Continuing Antiviral Therapy In Hbeag
We were unable to find comparative studies for this question. The Supporting Information summarizes uncontrolled studies and indirect evidence that may address this question. Data from these studies indicate a high rate of viral relapse when treatment was stopped, but rates of clinical relapse were lower.
Probbability Of Response To Treatment And Appearance Of Resistance
Treatment is indicated if there is a high risk of liver-related mortality and morbility and a high likehood of manteined viral supression after a defined course of therapy. This risk is variable during the course of HBV infection.
There are several treatment strategies for CHB: IFN and PEG-IFN, lamivudine, adefovir dipivoxil, telbivudine and entecavir. None of theses achieves complete HBV eradication and they have limited long-term efficacy. In the majority of patients, particularly those with HBeAg-negative disease, HBV is suppressed but not eradicated by treatment, and relapses occur when drug treatment is interrupted.
For HBeAg-negative patients, the sustained response is low: 15% show normalization of serum ALT and suppression of serum HBV DNA. For HBeAg-positive patients, the likelihood of response to nucleoside64/nucleotide analogs/PEG-IFN depends greatly upon degree of serum aminotransferase elevation. In general, treatment with any of these drugs does not result in higher rates of HBeAg seroconversion compared to non- treatment in those who have a serum ALT < 2 × ULN. After a year of treatment, HBeAg seroconversion occurs in < 10% of these patients treated with IFN, lamivudine or adefovir. ASSLD guidelines do not recommend treatment in normal ALT patients, because it is unlikely to achieve HbeAg seroconversion.
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Sensitivity Of Model Predictions With Respect To Changes In The Infected Cell Populations Initial Condition
Previous estimates for the percentage of HBV-infected hepatocytes vary between \ in chronic HBsAg carriers, and \ in acute infections,. We have derived our results by assuming that during chronic HBeAg-positive cases half of the liver is infected. Here, we investigate how changes in the size of the initial infected cell population alter our predictions. Analytical investigations show that the dynamics of the viral proteins HBsAg and HBeAg are not influenced by the initial size of the infected cell population, \. After treatment initiation \ = I_0 e^\), and \ and \ ). Therefore, the equations for S and E:
are independent of \. Moreover, for \\) and \\) we find that intracellular HBV DNA D depends on \ but HBV DNA in serum does not.
How Do I Treat My Hepatitis B
Not every patient with chronic hepatitis B needs to be on medication. Although there is no cure for hepatitis B, there are effective treatments that can reduce the risk of liver disease. However, if your ALT level is elevated , antiviral medication may be appropriate. There are currently 7 FDA-approved drugs to treat chronic HBV infection . Talk to your doctor about whether you are good candidate for drug therapy and make sure you discuss treatment rationale, options, side effects, and risks associated with each treatment.
Additionally, if you are chronically infected with hepatitis B and are starting cancer chemotherapy, you should be on HBV treatment to protect against potential flare-up of the hepatitis B infection and risk of liver failure.
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Medications For Hepatitis B
Several drugs are currently available for treatment of hepatitis B. Most of these are antiviral drugs that directly stop hepatitis B from reproducing. Hepatitis B treatment may also include pegylated interferon, which stimulates the body’s immune response against the virus.
Most hepatitis B drugs are nucleoside or nucleotide analogues, similar to one class of drugs used to treat HIV. In fact, some commonly used anti-HIV drugs are also active against hepatitis B. This can make treatment of both viruses easier, since it requires fewer drugs, but it must be done carefully to avoid either virus becoming resistant. These are:
- lamivudine .
- emtricitabine .
- tenofovir disoproxil or TDF .
- tenofovir alafenamide or TAF .
Other antiviral drugs are used to treat hepatitis B but not HIV:
- adefovir
- telbivudine .
Definitions Of A Cure Of Hbv Infection
There are several concepts around the definition of a cure of HBV infection. The ultimate goal of treatment would be to eradicate viral cccDNA from the liver leading to a complete and definite clearance of infected hepatocytes, thereby preventing the risk of reactivation in case of a loss of immune control. However, it is worth noting that this would not abolish the consequences of viral genome integration in the host chromosomes of infected cells, as this event could occur early after the onset of infection . On the other hand, in patients who spontaneously resolved viral infection with HBsAg clearance and anti-HBs seroconversion, cccDNA might not be completely eradicated, and the few persisting infected cells are supposed to be under the control of the host immune response. Therefore, a clinical or functional cure of infection could be defined by HBsAg clearance and HBsAb seroconversion, despite the lack of complete cccDNA eradication. The functional cure would be considered as long as the host immune response controls the infection and could be defined by the absence of relapse after treatment cessation. Another end point, which could be envisaged, is the control of infection, as observed in inactive carriersdefined by the persistence of low levels of serum HBsAg and HBV DNA levels with normal ALT levelsin which the HBV-specific immune response would be strong enough to keep viral replication under control, thereby allowing antiviral treatment cessation.
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Whats The Prognosis For Hepatitis B
Your doctor will know youâve recovered when you no longer have symptoms and blood tests show:
- Your liver is working normally.
- You have hepatitis B surface antibody.
But some people don’t get rid of the infection. If you have it for more than 6 months, youâre whatâs called a carrier, even if you donât have symptoms. This means you can give the disease to someone else through:
- Unprotected sex
Viral Load And Treatment: Unfavorable Arguments
Presently, the viral load cannot be considered as the only treatment criterion. HBV DNA persists even in persons who have serological recovery from acute HBV infection. Patients with low HBV-DNA levels, between 300 and 104 copies/mL, have, although a very low one, a risk of progression to cirrhosis and HCC. The progression in CHB infection is a multi-factorial process including interaction between host and environmental factors.
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What Are The Names Of The Medications For Treating Hepatitis C
Since 2014, multiple different antiviral treatments for hepatitis C have been developed. With the many options now available, often there is more than one good choice for a patient. Some of the treatments are recommended as first-line options, some are second-line options, and others are used less commonly in light of all the available choices.
- Elbasvir/Grazoprevir
Second line hepatitis C medications:
- Sofosbuvir/Velpatasvir/Voxelaprevir
Safety And Renal Side Effects Of Na Treatment
NAs are generally well tolerated. Adefovir and tenofovir may damage renal tubular cells and cause nephrotoxicity, but the risk seems to be low and the damage is mostly reversible . Nevertheless, patients treated with these drugs should be monitored for renal dysfunction . Tenofovir has been reported to cause loss in bone mineral density in patients infected with human immunodeficiency virus, though this phenomenon has not been noted in patients with HBV monoinfection . The same phenomenon has not been reported in patients with chronic hepatitis B . Entecavir may cause severe lactic acidosis in patients with impaired liver function and a MELD score of > 20 points . Interestingly, some patients receiving telbivudine showed an increase in glomerular filtration rates, especially those with preexisting mild renal impairment . However, it is not clear if this potential benefit can outweigh adverse effects of telbivudine, which are neuropathy and creatine kinase elevation .
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What About Patients With Hepatitis C Who Also Have Hepatitis B
Hepatitis B virus can flare in patients who are co-infected with hepatitis B and hepatitis C and are taking medication for hepatitis C. This has been reported as a potential risk for patients who are taking hepatitis C treatment and have underlying hepatitis B as well. The flare usually occurs within a few weeks after the patient starts taking medication for hepatitis C. Therefore, patients who have both hepatitis B and hepatitis C should be seen by a hepatitis expertbeforestarting treatment of the hepatitis C they may need to start taking hepatitis B treatment to avoid a hepatitis B flare.
What Is Ketogenic Diet
- Post date
Ketogenic or Keto Diet is popularly followed as a weight loss diet across the world.
Try this PYQ:
Q.Regular intake of fresh fruits and vegetables is recommended in the diet since they are a good source of antioxidants. How do antioxidants help a person maintain health and promote longevity?
They activate the enzymes necessary for vitamin synthesis in the body and help prevent vitamin deficiency.
They prevent excessive oxidation of carbohydrates, fats and proteins in the body and help avoid unnecessary wastage of energy.
They neutralize the free radicals produced in the body during metabolism.
They activate certain genes in the cells of the body and help delay the ageing process.
What is Ketogenic Diet?
- The Keto Diet is one of the most popular weight-loss diets the world over.
- It consists of a high-fat, moderate-protein and low-carb diet.
- It helps in weight loss by achieving ketosis a metabolic state where the liver burns body fat and provides fuel for the body, as there is limited access to glucose.
What constitutes a keto diet?
- A classic keto generally requires that 90 per cent of a persons calories come from fat, 6 per cent from protein and 4 per cent from carbs.
- But there are many versions doing the rounds since this one was designed for children suffering from epilepsy to gain control over their seizures.
How does it impact the body?
What impact does it have on our kidneys?
About Shyamji Krishna Varma
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