Tuesday, May 17, 2022

Can Hepatitis B Virus Be Cured

What Are The Signs & Symptoms Of Hbv Infection

Hepatitis B: Treatment and care for a chronic condition

HBV can cause a wide range of symptoms, from a mild illness and general feeling of being unwell to more serious chronic liver disease that can lead to liver cancer.

Someone with hepatitis B may have symptoms similar to those caused by other viral infections, like the flu. The person might:

  • be extra tired
  • feel like throwing up or actually throw up
  • not feel like eating
  • have a mild fever

HBV also can cause darker than usual pee, jaundice , and belly pain.

People exposed to hepatitis B may start to have symptoms from 1 to 6 months later. Symptoms can last for weeks to months.

In some people, hepatitis B causes few or no symptoms. But even someone who doesn’t have any symptoms can still spread the disease to others.

Prognosis Improvement After Hbsag Clearance

These related studies provide clear recommendations that patients who achieve HBsAg clearance have favourable clinical outcomes compared to patients who achieve only HBV DNA suppression and HBeAg seroconversion. HBsAg clearance leads to biochemical, virological and liver histological improvements, and it significantly reduces the risk of HCC. However, HCC may occur after HBsAg seroclearance despite it being the ultimate treatment endpoint recommended by current guidelines. The risk factors associated with HCC include the presence of cirrhosis, male sex, and age50 years at the time of HBsAg clearance . Closer attention should be given to patients with one or more of these risk factors.

These high-risk patients should be re-examined in a timely manner even if HBsAg clearance is obtained. These results also suggest that achieving a functional cure early in the absence of cirrhosis results in a better prognosis .

Inhibitors Of Hbv Cccdna Formation And Stability

Because the cytoplasmic nucleocapsid DNA is the precursor for cccDNA biosynthesis, complete inhibition of viral DNA replication in the nucleocapsids with polymerase inhibitors should preclude de novo cccDNA formation. However, clinical studies demonstrated that although NRTI monotherapy for 48-52 weeks reduced circulating viremia by â¼5 log10 and cytoplasmic HBV DNA levels in hepatocytes by approximately 2 log10, reduction of cccDNA was much less pronounced, only by 0.11 to 1.0 log10., Moreover, sequential analyses of viral DNA replicative intermediates and core antigen-positive hepatocytes in the livers of woodchuck hepatitis virus -infected woodchucks before and during clevudine therapy revealed that after more than 6 weeks of therapy, all WHV DNA replicative intermediates were markedly reduced, with the exception of cccDNA, which remained as the predominant viral DNA species in the liver.

Alternatively, failure to eradicate cccDNA by prolonged NRTI therapy may also be due to the extraordinary stability of cccDNA. cccDNA may persist in a âlatentâ state amid the host chromosomes and remain as a reservoir for later HBV replication. Healthy hepatocytes in the absence of immune response or inflammatory reaction have a half-life of over 6 months.,

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Treatment For Chronic Infection

Treatment for hepatitis B does not cure hepatitis B but works to delay or even to prevent complications from developing, like liver damage and ‘scarring’ of the liver . People with chronic hepatitis B usually need treatment to stop or to reduce the activity of the virus, so limiting liver damage. A liver specialist will usually advise on when treatment may be beneficial. There are two types of treatment currently given:

  • Interferon. This medicine is similar to a substance produced in your body, which is also called interferon. It works to fight infections by boosting your immune system. Interferon is usually given as an injection each week.
  • Antiviral medicines. These work by stopping the hepatitis B virus from multiplying in the body. They include lamivudine, adefovir, tenofovir, and entecavir. Your doctor will discuss these in more detail with you, as the medicine used can vary between people. A combination of antiviral medicines is sometimes used.

Treatment with medicines is usually continued for many years.

Side-effects with these medicines can occur. You will be monitored regularly while you are taking treatment, which includes blood tests. Some people need to change their medicines, or take a lower strength, if they have troublesome side-effects. Also, in some people, resistance can develop to their treatment medicine, which means that it does not work so well. If this happens then it is likely you will have to change the medicine you take.

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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.

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Present And Future Therapies Of Hepatitis B: From Discovery To Cure

Corresponding Author

T. Jake Liang

Liver Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD

Liver Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD

Stephan Urban

Department of Infectious Diseases, Molecular Virology and German Center for Infection Diseases, University Hospital Heidelberg, Heidelberg, Germany

Kyong-Mi Chang

Department of Medicine, Philadelphia Veterans Affairs Medical Center and the University of Pennsylvania Perelman School of Medicine, Philadelphia, PA

Corresponding Author

T. Jake Liang

Liver Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD

Liver Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD

Stephan Urban

Department of Infectious Diseases, Molecular Virology and German Center for Infection Diseases, University Hospital Heidelberg, Heidelberg, Germany

Kyong-Mi Chang

Department of Medicine, Philadelphia Veterans Affairs Medical Center and the University of Pennsylvania Perelman School of Medicine, Philadelphia, PA

Combination Studies Of Current Therapies

Given that only two classes of anti-HBV agents are currently available, combination therapy consist of two NRTIs or an NRTI plus PEG-IFN. In the latter case, an NRTI and PEG-IFN may be combined simultaneously, sequentially, starting with either drug first, or as an add-on strategy with either drug first.

Initially, the clinical need to increase the potency of first-generation antivirals and to prevent emergence of antiviral resistance was the primary reason to test combination therapy with NRTIs. Unfortunately, this approach suffered from the fact that all NRTIs have the same virological target, the HBV polymerase. Thus, the treatment response observed in patients was similar to that of the most potent agent in the combination. The issue of antiviral resistance is now greatly diminished with the development of second-generation NRTIs, such as entecavir and tenofovir. The efficacy and safety of entecavir and tenofovir combination therapy were compared to entecavir monotherapy in previously untreated HBV patients. A greater proportion of subjects receiving combination therapy achieved viral suppression compared to entecavir alone, but the difference was not statistically significant. However, HBeAg-positive subjects with baseline HBV DNA â¥108 IU/mL receiving combination therapy had a significantly higher rate of virological response compared to those receiving monotherapy.

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Are Alternative Medicines Available

Some people believe certain forms of alternative medicine help cure hepatitis C.

However, the National Center for Complementary and Integrative Health reports that there are no effective, research-proven forms of alternative treatment or complementary medicine for hepatitis C.

Silymarin, also known as milk thistle, is an herb commonly suggested to help cure hepatitis C liver disease. But a rigorous did not find any beneficial effects from this supplement.

Treatment For Chronic Hepatitis B

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If blood tests show that you still have hepatitis B after 6 months, your doctor may recommend medication to reduce the risk of complications of hepatitis B and regular tests to assess the health of your liver.

Treatment is usually offered if:

  • your immune system is unable to control the hepatitis B by itself
  • there’s evidence of ongoing liver damage

Hepatitis B medications can help keep the virus under control and stop it damaging your liver, although they will not necessarily cure the infection and some people need lifelong treatment.

The main medicines for chronic hepatitis B include peginterferon alfa 2-a and antiviral medicines.

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Durability And Related Factors After Hbsag Clearance

When patients with HBeAg-positive CHB achieve a satisfactory antiviral treatment endpoint , the clinical recurrence is 2040%, and the virological recurrence can be as high as 8090% after drug withdrawal . Because the safety of drug withdrawal is uncertain, HBsAg clearance is recommended as the ideal treatment endpoint for CHB patients. The accessibility and rate of HBsAg clearance was mentioned above, but the durability of HBsAg clearance after treatment cessation remains controversial.

HBeAg status should also receive attention in the pursuit of HBsAg clearance. The clearance of HBsAg in most patients is based on HBV DNA suppression and HBeAg seroconversion, but a few patients exhibit different HBsAg response patterns, such as HBsAg clearance without HBeAg seroconversion. Only HBsAg clearance based on HBV DNA suppression and HBeAg seroconversion is safe for drug withdrawal .

How Is Hepatitis B Diagnosed

There are three main ways to diagnose HBV infection. They include:

  • Blood tests: Tests of the blood serum shows how your bodys immune system is responding to the virus. A blood test can also tell you if you are immune to HBV.
  • Abdominal ultrasound: An ultrasound uses sound waves to show the size and shape of your liver and how well the blood flows through it.
  • Liver biopsy: A small sample of your liver tissue is removed though a tiny incision and sent to a lab for analysis.

The blood test that is used to diagnose hepatitis B is not a test that you get routinely during a medical visit. Often, people whove become infected first learn they have hepatitis B when they go to donate blood. Blood donations are routinely scanned for the infection.

The virus can be detected within 30 to 60 days of infection. About 70% of adults with hepatitis B develop symptoms, which tend to appear an average of 90 days after initial exposure to the virus.

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If I Am Infected How Can I Prevent Passing On The Virus To Others

If you have a current hepatitis B infection you should:

  • Avoid having sex with anyone until they have been fully immunised and checked with a blood test to see that the immunisation has worked.
  • Not share any injecting equipment such as needles, syringes, etc.
  • Not donate blood or semen or carry a donor card.
  • Not share razors, toothbrushes, etc, that may be contaminated with blood.
  • Cover any cuts or wounds with a dressing.
  • Make sure that, if any of your blood spills on to the floor or other surfaces following an accident, it is cleaned away with bleach.

From Person To Person

Push to cure hepatitis B, a neglected disease

Blood and other bodily fluids, such as semen and vaginal secretions, contain the virus in infected people. The main ways in which people in the UK become infected include the following:

  • Having unprotected sex with an infected person. Even having oral sex can transmit hepatitis B.
  • From infected blood. You only need a tiny amount of infected blood to come into contact with a cut or wound on your body to allow the virus to enter your bloodstream, multiply and cause infection. For example:
  • Sharing needles and/or any injecting equipment to inject drugs. Even a tiny amount of blood left on a needle from an infected person is enough to cause spread to others.
  • Some people who had a blood transfusion or another blood product several years ago were infected with hepatitis B. Now, all blood donated in the UK is checked for the hepatitis B virus . So, the risk of getting hepatitis B from a blood transfusion in the UK is now very small.
  • From ‘needlestick’ accidents where the needle was used on an infected person.
  • There is a small risk of contracting the virus from sharing toothbrushes, razors and other such items which may be contaminated with blood. The virus can actually live outside the body for more than one week.
  • From using equipment which is not sterile for dental work, medical procedures, tattooing, body piercing, etc.
  • A bite from an infected person, or if their blood spills on to a wound on your skin, or on to your eyes or into your mouth.

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Emergency Hepatitis B Treatment

See your GP as soon as possible if you think you may have been exposed to the hepatitis B virus.

To help stop you becoming infected, they can give you:

  • a dose of the hepatitis B vaccine you’ll also need 2 further doses over the next few months to give you long-term protection
  • hepatitis B immunoglobulin a preparation of antibodies that work against the hepatitis B virus and can offer immediate but short-term protection until the vaccine starts to take effect

These are most effective if given within 48 hours after possible exposure to hepatitis B, but you can still have them up to a week after exposure.

Chronic Hepatitis B Infection

If you develop chronic hepatitis B, youll be given treatment to reduce the risk of permanent liver damage and liver cancer. Treatment does not cure chronic hepatitis B and most people who start treatment need to continue for life.

Without treatment, chronic hepatitis B can cause scarring of the liver , which can cause the liver to stop working properly.

A small number of people with cirrhosis develop liver cancer, and these complications can lead to death. Other than a liver transplant, there is no cure for cirrhosis. However, treatments can help relieve some of the symptoms.

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How Is Hepatitis B Transmitted

Hepatitis B is spread in several distinct ways: sexual contact sharing needles, syringes, or other drug-injection equipment or from mother-to-child at birth.

In the United States, in 2018, injection drug use was the most common risk factor reported among people with an acute HBV infection, followed by having multiple sex partners. Less commonly reported risk factors included accidental needle sticks, surgery, transfusions, and household contact with a person with HBV infection. In the United States, healthcare-related transmission of HBV is rare.

Mother-to-child transmission of HBV is especially concerning, because it is preventable. An estimated 25,000 infants are born to mothers diagnosed with HBV each year in the United States, and approximately 1,000 mothers transmit HBV to their infants. Without appropriate medical care and vaccinations, 90% of HBV-infected newborns will develop chronic infection, remaining infected throughout their lives. Up to 25% of people infected at birth will die prematurely of HBV-related causes. For this reason, the standard of care for pregnant women includes an HBV test during each pregnancy so that the appropriate steps can be taken to prevent HBV-positive mothers from transmitting the disease to her infant.

Hbv Replication: From Basic Science To Drug Development

Hepatitis C Can Be Cured

Advances in understanding the molecular biology and replication cycle of HBV have provided unprecedented insight into the mechanisms of action and treatment response of currently available drugs against HBV as well as potential future targets for therapeutic development . HBV gains entry into hepatocytes initially through a low-affinity interaction between heparan sulfate proteoglycans on the hepatocytes involving the antigenic loop of the HBV envelope proteins, and then a high-affinity interaction of the myristoylated pre-S1 domain with the liver-specific receptor sodium/taurocholate cotransporter . NTCP is exclusively expressed on the basolateral/sinusoidal membrane of hepatocytes. Its natural function is to transport conjugated bile salts into hepatocytes as part of the enterohepatic pathway. Accordingly, NTCP plays a key role in the liver tropism of HBV., NTCP is also crucial for the host specificity of HBV. Two short sequence motifs within NTCP are sufficient to render the respective proteins from cynomolgus monkey and mouse functioning as an HBV receptor., Additional host factors are probably required for efficient HBV entry. Fusion of HBV particles and release of nucleocapsids into the cells involves receptor-mediated endocytosis.,

Figure 1

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How Is Hepatitis B Prevented

Testing & Vaccination

  • The hepatitis B vaccine offers excellent protection against HBV. The vaccine is safe and highly effective. Vaccination consists of 3 doses of vaccine over the course of 6 months. Protection lasts for 20 years to life.
  • The American Academy of Pediatrics recommends that all children should receive hepatitis B vaccine starting at birth. .
  • The CDC recommends hepatitis B vaccine for persons traveling to countries where HBV is common .
  • If you have one or more risk factors for hepatitis B infection, you should get a simple HBV blood test. The blood test will determine whether you are:
  • immune to hepatitis B or
  • susceptible to hepatitis B and need vaccination or
  • infected with hepatitis B and need further evaluation by a physician
  • The basic test for acute HBV infection is called the Hepatitis B Core IgM Antibody test. People who have acute hepatitis B show positive IgM antibodies on this test.
  • Perinatal Hepatitis

    • California law requires testing of all pregnant women for hepatitis B infection
    • If the mother is HBV-infected, she will pass the infection to the baby during the birth process, unless the baby gets immunized within hours of birth
    • Giving the infant HBIG and HBV vaccine right away will reliably prevent infection of the infant
    • Other family members should best tested for hepatitis B too, and given vaccine if they are not already infected or immune

    Healthy Habits

    After Exposure to Hepatitis B

    What Is Hepatitis B

    Hepatitis B is an infection of your liver. Itâs caused by a virus. There is a vaccine that protects against it. For some people, hepatitis B is mild and lasts a short time. These âacuteâ cases donât always need treatment. But it can become chronic. If that happens, it can cause scarring of the organ, liver failure, and cancer, and it even can be life-threatening.

    Itâs spread when people come in contact with the blood, open sores, or body fluids of someone who has the hepatitis B virus.

    It’s serious, but if you get the disease as an adult, it shouldnât last a long time. Your body fights it off within a few months, and youâre immune for the rest of your life. That means you can’t get it again. But if you get it at birth, itâ unlikely to go away.

    âHepatitisâ means inflammation of the liver. There are other types of hepatitis. Those caused by viruses also include hepatitis A and hepatitis C.

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