Who Is At A Greater Risk Of Hepatitis B Viral Infection
Hepatitis B viral infection can occur in any individual. However, a certain group of people are at a higher risk of developing hepatitis B viral infection. Doctors generally recommend the blood test to screen patients with hepatitis B viral infection. The screening test is generally done for people who are prone to hepatitis B. Screening is important to isolate or alert the people infected with the virus so that the transmission of the virus can be controlled. The people at a greater risk of developing hepatitis B viral infection include:
Molecular Mechanisms Of Drug Resistance
Different types of mutations are associated with drug resistance and can emerge during antiviral therapy with nucleoside or nucleotide analogues. Primary mutations typically affect the reverse transcriptase domain of the HBV polymerase, thereby causing steric changes of the polymerase protein that escape the inhibitory effects of the nucleoside analogues . The most relevant hot-spot mutations in the HBV polymerase are displayed in Table 1. However, the polymerase mutants have a dramatically reduced viral replication efficacy in most cases . Secondary compensatory mutations occur in order to restore the viral replication fitness, thereby overcoming deleterious effects of the primary drug-resistant mutations . These mutations are not necessarily located within the enzymatically active sites of the polymerase, but oftentimes stabilize secondary or tertiary viral structures. The eight different HBV genotypes AH partly differ with respect to the position of secondary compensatory mutations and the rate of drug resistance development .
Table 1
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Clinical And Pathological Manifestations Of Drug
Drug hepatotoxicity manifests with clinical signs and symptoms caused by an underlying pathological injury. The clinical presentation may or may not suggest the underlying liver injury, and therefore, the types of injuries are sometimes described separately. Some drugs usually cause one clinical and pathologic injury and other drugs can cause a variety of injuries, often making the diagnosis more challenging.
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Hepatitis B And Pregnancy
If youâre pregnant, you might pass the virus to your baby at birth.
If your baby gets the virus and isnât treated, they could have long-term liver problems. All newborns with infected mothers should get hepatitis B immune globulin and the vaccine for hepatitis at birth and during their first year of life.
How Does Hepatitis C Treatment Work
- Hepatitis C treatment stops the virus from making copies of itself, and over the weeks of treatment, the virus is cleared from your body.
- The type of treatment you get is not affected by your use of drugs.
- Another medicine called ribavirin may be added to your treatment if your liver is severely injured.
- A nurse or doctor will help you choose the best treatment for you. The goal is to make treatment safe, effective and tolerable.
- After being cured, you will still test positive for antibodies to the hepatitis C virus for the rest of your life. This does not mean that you have hepatitis C.
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Warnings Issued By The Fda
In April 2010, the FDA had added a boxed warning, the strongest warning issued by the FDA, to the prescribing information for propylthiouracil. The boxed warning emphasizes the risk for severe liver injury and acute liver failure, which may be fatal. The boxed warning also states that propylthiouracil should be reserved for use in those who cannot tolerate other treatments such as methimazole, radioactive iodine, or surgery.
The decision to include a boxed warning was based on the FDA’s review of postmarketing safety reports and meetings held with the American Thyroid Association, the National Institute of Child Health and Human Development, and the pediatric endocrine clinical community.
In 2009, the FDA issued guidelines to assist the pharmaceutical industry and other investigators who are conducting new drug development in assessing the potential for a drug to cause severe liver injury . In particular, the guidance addresses how laboratory measurements that signal the potential for such drug-induced liver injury can be obtained and evaluated during drug development.
In June 2009, the FDA issued a report that identified 32 cases of serious liver injury associated with propylthiouracil . Of the adults, 12 deaths and 5 liver transplants occurred, and among the pediatric patients, 1 death and 6 liver transplants occurred. PTU is indicated for hyperthyroidism due to Graves disease.
The FDA recommends the following criteria be considered for prescribing PTU:
What Raises Your Chances Of Getting It
You may be more likely to get toxic liver disease if:
- You take OTC pain relievers more than the recommended dose, with chronic alcohol use.
- You already have another liver disease, like cirrhosis, nonalcoholic fatty liver disease, or hepatitis.
- You drink alcohol while you take certain medications or supplements.
- You work in a job that uses industrial chemicals that could be toxic.
- Youâre older.
- You have a gene mutation that affects how well your liver works.
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What Causes Toxic Hepatitis
Toxic hepatitis is usually caused by exposure to certain organic chemicals or solvents, certain medications, drugs or alcohol.
Many chemicals and drugs can cause liver damage. However, people respond differently to different medications. Some people may have an adverse reaction to certain drugs and can suffer liver damage, while others may not. Excessive drinking that causes liver damage can make the harmful effects of drug or chemical exposure worse.
Types of toxic hepatitis include:
- Chemical-induced hepatitis: Exposure to toxic chemicals in the workplace, such as organic chemicals and solvents, is a common cause of toxic hepatitis. Exposure can occur through ingesting a chemical, breathing it in, or through contact with the skin.
- Drug-induced hepatitis: Many prescription and over-the-counter medications may cause liver toxicity or hepatitis , including:
- Dark-colored urine
- Fluid in the abdomen
It may take days, weeks or even months for symptoms to appear after exposure to the chemicals or drugs. Symptoms may be similar to those of other liver disorders.
In chronic cases of toxic hepatitis, extensive liver damage, such as cirrhosis may occur. The patient may also develop severe liver failure, which can be life-threatening.
Clinical Course And Diagnosis Of Drug Induced Liver Disease
The clinical symptoms, signs and patterns of liver test abnormalities of drug induced liver injury can mimic virtually any form of liver disease from acute viral hepatitis to gall stone disease with biliary obstruction, acute fatty liver and even chronic hepatitis and cirrhosis. There are no specific findings or laboratory tests that definitely prove that a suspected drug, nutritional supplement or herbal product is the cause of the injury. Drug induced liver injury is a diagnosis of exclusion and relies upon clinical judgment and knowledge about the potential of the agent to cause liver injury versus the likelihood that other forms of liver diseases are the cause. For some medications, the pattern of clinical presentation and liver test abnormalities strongly suggest that the drug is the cause of the liver injury, but ultimately the more common causes of liver disease must be ruled out before a drug is considered the likely cause.
In judging the likelihood of drug induced liver disease, six features are important:
- the onset after starting the drug: time to onset
- the recovery after stopping the drug: time to recovery
- the clinical pattern: injury pattern and clinical phenotype
- exclusion of other causes of liver injury
- whether the drug is a known cause of liver injury
- response to reexposure, whether inadvertent or intentional
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Do You Have Hepatitis C Do You Use Drugs
If you answered yes, this booklet is for you.
Keep reading!
Lots of people have hepatitis C. Hepatitis C is passed through blood-to-blood contact. A common way to get hepatitis C is through sharing equipment for using drugs.
This includes sharing needles, syringes, filters, washes, water and cookers used for preparing or injecting drugs, pipes or stems and mouthpieces for smoking drugs, and rolled paper or straws for snorting drugs.
Hepatitis B Causes And Risk Factors
Itâs caused by the hepatitis B virus, and it can spread from person to person in certain ways. You can spread the hepatitis B virus even if you donât feel sick.
The most common ways to get hepatitis B include:
- Sex. You can get it if you have unprotected sex with someone who has it and your partnerâs blood, saliva, , or vaginal secretions enter your body.
- Sharing needles. The virus spreads easily via needles and syringes contaminated with infected blood.
- Accidental needle sticks.Health care workers and anyone else who comes in contact with human blood can get it this way.
- Mother to child.Pregnant women with hepatitis B can pass it to their babies during childbirth. But thereâs a vaccine to prevent newborns from becoming infected.
Hepatitis B doesnât spread through kissing, food or water, shared utensils, coughing or sneezing, or through touch.
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When To Seek Medical Advice
See your GP if you persistently have any of the later symptoms above, or if they keep returning. They may recommend having a blood test that can check for hepatitis C. Read more about diagnosing hepatitis C.
None of the symptoms above mean you definitely have hepatitis C, but it’s important to get them checked out.
You should also speak to your GP about getting tested if there’s a risk you’re infected, even if you don’t have any symptoms. This particularly includes people who inject drugs or have done so in the past.
Read about the causes of hepatitis C for more information about who’s at risk of having the infection.
World Health Organization Recommendations
The 2015 WHO guidelines for the prevention, care, and treatment of persons with chronic hepatitis B infection indicate 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 .
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Exclusion Of Other Diagnoses
The final important element in diagnosis of drug induced liver disease is exclusion of other diagnoses. The clinical signature often dictates which liver diseases are most important to exclude. A basic approach to ruling out other liver conditions in a patient suspected of having drug induced liver disease would include:
A careful history, focusing on:
- Risk factors for viral hepatitis
What If I Have Bad Veins And Need To Get A Blood Test
You will need to do blood tests when you get hepatitis C treatment and to find out if you are cured. Getting blood tests can be difficult if you have bad veins, but there are things you can do to make the tests easier:
- Drink two or three glasses of water one to two hours before your test.
- Bring a friend for support.
- Show the nurse or doctor your best veins.
- Warm your body by taking a shower and wearing warm clothes to your blood test.
- Speak with your nurse or doctor about other ways to make the blood tests easier.
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If I Am Still Using Drugs Can I Get Treated For Hepatitis C
Yes! You can still get high and be treated and cured for hepatitis C. You can also be treated and cured if you drink alcohol. Treatment for hepatitis C can help your health.
You deserve respectful care by doctors, nurses and other health workers. Ask harm reduction workers or other people who use drugs about which nurses and doctors are good to work with.
This Vaccine Side Effects
Get emergency medical help if you have signs of an allergic reactionor a severe skin reaction .
You should not receive a booster vaccine if you had a life-threatening allergic reaction after the first shot.
Keep track of any and all side effects you have after receiving this vaccine. When you receive a booster dose, you will need to tell the doctor if the previous shot caused any side effects.
Hepatitis B adult vaccine may cause serious side effects. Call your doctor at once if you have:
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a light-headed feeling, like you might pass out
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seizure-like muscle movements or
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redness, pain, swelling, or a lump where the shot was given.
This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report vaccine side effects to the US Department of Health and Human Services at 1-800-822-7967.
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How Do Doctors Diagnose Drug
The diagnosis of drug-induced liver diseases often is difficult. Patients may not have symptoms of liver disease or may have only mild, nonspecific symptoms. Patients may be taking multiple drugs, which makes it difficult to identify the offending drug. Patients also may have other potential causes of liver diseases such as non-alcoholic fatty liver disease and alcoholism.
The diagnosis of liver disease is based on a patient’s symptoms , findings on the physical examination , and abnormal laboratory tests . If a patient has symptoms, signs, and abnormal liver tests, doctors then try to decide whether drug are causing the liver disease by doing the following:
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 Are The Symptoms
- Allopurinol for gout
- Antiviral drugs for HIV infection
Chemotherapy. This common cancer treatment is another possible cause. These drugs are toxins and may stress your liver.
Herbal supplements. How could something natural be bad for your liver? In fact, some common herbs could cause toxic liver disease. Watch out for supplements that contain aloe vera, black cohosh, cascara, chaparral, comfrey, ephedra, or kava.
Chemicals and solvents. Some workplace chemicals can harm your liver. Some examples are vinyl chloride, which is used to make plastics a dry cleaning solution called carbon tetrachloride the weed killer paraquat and polychlorinated biphenyls.
Treatment For Chronic Hepatitis B Infection
Most people diagnosed with chronic hepatitis B infection need treatment for the rest of their lives. The decision to start treatment depends on many factors, including: if the virus is causing inflammation or scarring of the liver, also called cirrhosis if you have other infections, such as hepatitis C or HIV or if your immune system is suppressed by medicine or illness. Treatment helps reduce the risk of liver disease and prevents you from passing the infection to others.
Treatment for chronic hepatitis B may include:
Other drugs to treat hepatitis B are being developed.
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Valproic Acid And Divalproex Sodium
Microvesicular steatosis is observed with alcohol, aspirin, valproic acid, amiodarone, piroxicam, stavudine, didanosine, nevirapine, and high doses of tetracycline. Prolonged therapy with methotrexate, INH, ticrynafen, perhexiline, enalapril, and valproic acid may lead to cirrhosis. Valproic acid typically causes microsteatosis. This drug should not be administered to patients with hepatic disease exercise caution in patients with a prior history of hepatic disease. Those at particular risk include children younger than 2 years, those with congenital metabolic disorders or organic brain disease, and those with seizure disorders treated with multiple anticonvulsants.
Hepatic failures resulting in fatalities have occurred in patients receiving valproic acid. These incidents usually occur during the first 6 months of treatment and are preceded by nonspecific symptoms such as malaise, weakness, lethargy, facial edema, anorexia, vomiting, and even loss of seizure control. Liver function tests should be performed prior to therapy and at frequent intervals, especially in the first 6 months. Physicians should not rely totally on laboratory results they should also consider findings from the medical history and physical examination.