Closing In On A Cure For Hepatitis B
For Thomas Tu, eliminating hepatitis B is a deeply personal goal.
Tu, a molecular virologist at the Westmead Institute for Medical Research in Sydney, Australia, learnt he had chronic hepatitis B as a teenager. A blood test revealed telltale signs of the infectious liver disease, which Tu had probably acquired at birth.
In his late 20s, Tu started taking a medication to limit the viruss replication and prevent collateral damage to his liver cells. Now 36, he has been on that daily treatment a pill known as a nucleoside analogue ever since.
Yet, even with a therapy that keeps his infection well under control, Tu remains at heightened risk for liver disease. He must juggle visits to specialist doctors and bear prescription-drug costs. And he knows that many others racked by the financial instability, emotional toil and stigma that the lifelong infection can bring have it much worse.
Im in this quite privileged space to be able to be on therapy and not have any side effects or feel any burden from taking daily medicines, Tu says. Thats not the same for the majority of people living with hepatitis B.
We are using all our weapons to tackle every single step of the virus, says Man Fung Yuen, a hepatologist at the University of Hong Kong.
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Can Hepatitis B Be Prevented
The best way to prevent hepatitis B is to get the hepatitis B vaccine.
You can also reduce your chance of hepatitis B infection by:
- Not sharing drug needles or other drug materials
- Wearing gloves if you have to touch another persons blood or open sores
- Making sure your tattoo artist or body piercer uses sterile tools
- Not sharing personal items, such as toothbrushes, razors, or nail clippers
- Using a latex condom during sex. If your or your partner is allergic to latex, you can use polyurethane condoms.
If you think you have been in contact with the hepatitis B virus, see your health care provider right away. Your provider may give you a dose of the hepatitis B vaccine to prevent infection. In some cases, your provider may also give you a medicine called hepatitis B immune globulin . You need to get the vaccine and the HBIG as soon as possible after coming into contact with the virus. It is best if you can get them within 24 hours.
National Institute of Diabetes and Digestive and Kidney Diseases
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New Prospective Antiviral Treatment Strategies
Recently, there is a growing interest in some new therapeutic strategies, targeting viral life cycle or improving antiviral immune response, that could eliminate all replicative intermediates, including ccc-DNA. The drugs targeting different steps of HBV life cycle include entry inhibitors polymerase inhibitors core protein inhibitors HBsAg release inhibitors RNA silencers. On the other hand, the new therapies to improve anti-HBV immunity response include therapeutic vaccines, generating new T cells toll-like receptor 7 and toll-like receptor 8 agonists, stimulating antiviral effector cells retinoic acid-inducible gene I agonist anti-HBV antibodies checkpoint inhibitors programmed cell death protein 1 and PD1 ligand inhibitors, rescuing the T-cell exhaustion that can be observed in chronic HBV infection. Results of preclinical and early clinical studies are promising thus, soon, these treatment options could be available and could potentially transform the future indications for hepatitis B treatment.
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Hepatitis B Treatment: Medication
There are five FDA-approved oral medications and one injection available to treat hepatitis B. The newer oral medications are stronger and less likely to develop viral resistance and have very few side effects.
The medication cannot cure the disease, but can help reduce the number of viruses in the body and the risk of complications. You may undergo periodic blood tests to monitor drug resistance and determine whether the medication is having an effect.
Personal Stories About Using Antiviral Therapy For Hepatitis B
These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.
My doctor says I have a good chance of doing well on interferon. My HBV DNA test showed that I have a pretty low level of the virus in my body. And my blood tests showed that my liver enzymes are high. Those factors mean I might do well on the medicine. And I guess women have better success than men, so that’s another thing in my favor. I’m not wild about giving myself shots, but I’d rather do that than have major liver damage.
Barbara, age 45
I found out a couple of years ago that I have hepatitis B. I thought about taking any medicine I could to help my liver. But so far, my tests show that my liver is in good shape. My liver enzyme levels are normal, even though I still have the virus in my body. It might not do me any good to take medicines yet. I’ll have my liver checked regularly, and if things change, I’ll reconsider.
Phil, age 28
I’ve got diabetes as well as infection with hepatitis B virus. That means my immune system may not be as strong as it could be, so interferon may not help me much. But some people do really well on entecavir. I also like the fact that I can take it as a pill and do not have to have shots.
Jamal, age 34
Teresa, age 55
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What Treatments Are Available For Chronic Hepatitis B
Hepatitis B
Hepatitis B treatment is based on the results of blood tests, age, and the degree of scarring in the liver. Hepatitis B treatment is recommended for patients with very active virus and an inflamed liver. People with chronic hepatitis B and cirrhosis also may be candidates for treatment.
Treatment involves taking an oral antiviral medication. In some cases, injections may be used.
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European Commission And Thervacb Join Forces
The role of viral hepatitis as a public health threat has long been underestimated. Only very recently, the United Nations in their 2030 Agenda for Sustainable Development called for international action to combat viral hepatitis and reduce the disease burden. The major killer is the hepatitis B virus causing liver cirrhosis and liver cancer. Worldwide 880,000 humans die each year from the consequences of an HBV infection.
A prophylactic vaccine is available to prevent HBV infection, but more than 3% of the worlds population are chronically infected and do not profit from that vaccine anymore. For those suffering from chronic hepatitis B, until today no curative treatment option exists.
The European Commission therefore selected the project TherVacB led by Helmholtz Zentrum München for a five-year funding within the Horizon 2020 program. A consortium of leading virologists, immunologists and physicians specialized in treating viral hepatitis, will use a newly designed therapeutic vaccine, TherVacB, as an immunotherapy to cure HBV. TherVacB will be evaluated in a three-year clinical trial starting in 2022 conducted in Europe and in Africa. Integration of a partner site in Tanzania shall help building local capacities for diagnosing and treating hepatitis B and support an important goal of the consortium to raise awareness for hepatitis B.
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Key Points About Drug
- Drug-induced hepatitis is a redness and swelling of the liver.
- It is a rare condition caused by harmful amounts of certain medicines, vitamins, herbal remedies, or food supplements.
- In most cases, you may be taking a medicine for several months before it reaches a toxic level and affects your liver.
- You may also get the condition if you take too much of some medicines, such as acetaminophen. This can happen quickly.
- You must stop taking the medicine that is causing the disease.
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.
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Treatment For Acute Hepatitis B
If youre 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 youll be advised to have regular blood tests to check that youre free of the virus and have not developed chronic hepatitis B.
How Is It Transmitted
Hepatitis B is highly infectious, and is spread from one person to another through exposure to infected blood and body fluids . It can be spread through:
- blood transfusions or organ transplantation in countries where blood or blood products have not been properly screened for hepatitis B and other viruses transmitted through blood
- unprotected sex with an infected person
- sharing needles or equipment for injecting drugs
- unsterilized medical/dental equipment and shared/contaminated materials or equipment used for tattooing, body piercing or acupuncture
- sharing toothbrushes or razors
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Treatment For Hepatitis B In Patients With Drug Resistance
Frank Tacke, Daniela C. Kroy
Department of Medicine III, RWTH Aachen University Hospital, Aachen, Germany
Contributions: Conception and design: All authors Administrative support: None Provision of study materials or patients: None Collection and assembly of data: None Data analysis and interpretation: None Manuscript writing: All authors Final approval of manuscript: All authors.
Correspondence to:
Keywords: Hepatitis B virus antiviral drug resistance polymerase
Submitted Jul 28, 2016. Accepted for publication Aug 24, 2016.
doi: 10.21037/atm.2016.09.19
What Is Chronic Hepatitis B
Doctors refer to hepatitis B infections as either acute or chronic:
- An acute HBV infection is a short-term illness that clears within 6 months of when a person is exposed to the virus.
- A person who still has HBV after 6 months is said to have a chronic hepatitis B infection. This is a long-term illness, meaning the virus stays in the body and causes lifelong illness. An estimated 850,000 to more than 2 million people in the U.S. have chronic HBV.
The younger someone is when infected, the greater the chances for chronic hepatitis B. About 90% of babies with HBV will develop a chronic infection. That risk drops to 6%10% when someone over 5 years old is infected. Because of this, the World Health Organization and the Centers for Disease Control and Prevention recommend that all babies get the first dose of the hepatitis B vaccine within 1224 hours of birth. Theyll get two more doses later, at 12 months of age and at 618 months of age.
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Approved Drugs For Adults
There are currently 7 approved drugs in the United States for adults living with chronic hepatitis B infection. These include 5 types of antiviral drugs that are taken as a pill once a day for 1 year or longer. And there are 2 types of immune modulator drugs called interferon that are given as an injection for 6 months to 1 year.
It is important to know that not everyone needs to be treated. A liver specialist should evaluate your health through a physical exam, blood tests, and an imaging study of your liver . Then you can discuss together whether you are a good candidate for treatment since the approved drugs are most effective when there are signs of active liver disease. In addition, talk to your provider about HBV Clinical Trials since there are several new drugs being tested that are available for infected adults.
All adults, however, should be seen regularly by a liver specialist whether they are on treatment or not.
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.
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What Does Treatment With The New Drugs Involve
The drugs are easy to take and are taken orally.
Treatment time is usually 12 weeks. However this may range between 8 and 24 weeks for a complete course of treatment, depending on the patients genotype, whether the patient has cirrhosis, treatment history and which of the drug combinations the prescriber chooses to use.
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What Treatments Are Available For Viral Hepatitis
Many medications are available for the treatment of chronic HBV and HCV infection. For chronic HBV infection, there are several antiviral drugs. People who are chronically infected with HBV require consistent medical monitoring to ensure that the medications are keeping the virus in check and that the disease is not progressing to liver damage or cancer.
There are also antiviral medications available for HCV treatment and new treatments have been approved in recent years. Many antiviral HCV treatments can cure more than 90 percent of people who take them within 8 to 12 weeks. HCV treatment dramatically reduces deaths, and people who are cured are much less likely to develop cirrhosis or liver cancer. However, not everyone infected with HCV needs or can benefit from treatment. NIDA researchers have identified genes that are associated with spontaneous clearance of HCV. These genes also enable people who are unable to clear HCV on their own to respond more favorably to treatment medications. This new information can be used to determine which patients can benefit most from HCV treatment. More studies must be done, but this is a first step to personalized medicine for the treatment of HCV.
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How Are Hepatitis B And C Treated
Hepatitis B: Not all patients with chronic hepatitis B infection require treatment. At Yale Medicine, specialists decide on an individual basis whether a patient is an appropriate candidate for treatment. Generally, patients require treatment when their hepatitis B virus level is high, and when laboratory tests demonstrate significant inflammation or injury to the liver.
There are currently seven approved drugs for hepatitis B, two of which are considered to be first-line treatments. These drugs are oral pills taken once daily, and while they’re very effective at suppressing the virus to very low or undetectable levels over the long term, they are not considered curative.
Therefore, the goal of treatment is to control the virus long-term and decrease the risk of hepatitis B related complications such as cirrhosis and liver cancer.
Hepatitis C: For the greater part of the last 20 years, treatment of hepatitis C required the use of a chemotherapy-like injection drug called interferon, which has been associated with serious side effects and a low cure rate. Fortunately, advances in hepatitis C treatments within the last three years now allow for the use of oral medications that are significant improvements in terms of safety and effectiveness.
What Are The Other Health Challenges For People With Hepatitis Who Inject Drugs
People with hepatitis who inject drugs often have several other health conditions at the same time, including mental illness and HIV/AIDS, thus requiring care from multiple health care providers. This is sometimes referred to as co-occurring disorders. Substance use disorder treatment is critical for PWID, as it can reduce risky behaviors that increase the chance of transmitting hepatitis. Research has shown that patients with hepatitis receiving medication-assisted treatment for their opioid addiction can be safely treated with antiviral medications.5
To enhance HCV care, NIDA is examining coordinated care models that utilize case managers to integrate HCV specialty care with primary care, substance use disorder treatment, and mental health services so that these patients get treatment regimens that address all of their health care needs. The Health Resources and Services Administrations Ryan White HIV/AIDS Program developed a free, online curriculum about HIV/hepatitis C for healthcare providers and healthcare staff to increase knowledge about co-infection among people of color in the United States.
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