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How Can Hepatitis B Be Treated

Treatment For Acute Hepatitis B

Hepatitis B: Treatment and care for a chronic condition

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.

Discussing Screening Results With Clients

The medical personnel who ordered or arranged the screening test, not counselors, usually explain the results. Hepatitis screening should be part of the intake physical examination in an opioid treatment program, and medical personnel may report the results. However, the client may want to discuss the results with the counselor or ask the counselor questions.

Anxiety might interfere with some clients ability to comprehend or retain information, which might need to be repeated.

Suggestions for conversations with clients when the test results are negative include the following:

  • Explain results clearly and simply: So the HCV screening result was negative? This means that, as of 6 months ago, you did not have .
  • Emphasize that a negative result to an HCV test does not indicate to and that the client should take precautions to avoid . If a relapse to drug use occurs, advise clients to avoid sharing any drug paraphernalia or equipment. Specify that this includes cookers, cotton, water, needles, syringes, pipes, and straws.
  • Emphasize the importance of getting HAV and HBV vaccinations. Provide information about the availability of low- or no-cost vaccinations.

Clients whose screening test results are positive for will need additional tests and examinationsusually with doctors who specialize in diseases of the liver to get accurate diagnoses and to determine their health status and the extent of liver damage. These tests are described in .

Treatment For Chronic Hbv Infection

For chronic HBV infection, antiviral medications are available.

This is not a cure for chronic HBV. However, it can stop the virus from replicating and prevent its progression into advanced liver disease.

A person with a chronic HBV infection can develop cirrhosis or liver cancer rapidly and without warning. If a person does not have access to adequate treatment or facilities, liver cancer can be fatal within months of diagnosis.

People with a chronic HBV infection require ongoing medical evaluation and an ultrasound of the liver

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How Many People Have Hepatitis B

In the United States, an estimated 862,000 people were chronically infected with HBV in 2016. New cases of HBV infection in the United States had been decreasing until 2012. Since that time, reported cases of acute hepatitis B have been fluctuating around 3,000 cases per year. In 2018, 3,322 cases of acute hepatitis B were reported however, because of low case detection and reporting, the Centers for Disease Control and Prevention estimates that there were 21,600 acute hepatitis B infections. New HBV infections are likely linked to the ongoing opioid crisis in the United States.

Globally, HBV is the most common blood-borne infection with an estimated 257 million people infected according to the World Health Organization .

Barriers To Eliminating Hbv

Hepatitis B Reactivation with Hepatitis C Treatment

Persistence of cccDNA and its ability to selfreplenish and the lack of direct effects of current therapies on cccDNA account for the difficulty in eliminating cccDNA. There are additional barriers to eliminating HBV. HBV DNA can be integrated into the host genome. Although integrated HBV DNA is often rearranged and/or partially deleted and there is no evidence that it supports the full cycle of HBV replication, recent studies suggest that integrated HBV DNA can be sufficiently intact to support translation of viral proteins, e.g., HBsAg.5 Elimination of integrated HBV DNA will likely require the removal of hepatocytes that harbor these DNA. Control of infections generally requires elimination of the infectious organisms coupled with activation of specific immune responses. Whereas patients who recover from acute HBV infection display rigorous immune responses to multiple HBV epitopes, patients with chronic HBV infection manifest weak immune responses to very few HBV epitopes.6

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Get Treatment If Your Provider Tells You To

Usually, no medicine is used to treat an acute infection. But if you have chronic hepatitis B, your healthcare provider may give you medicine to treat it. The medicines are called antiviral drugs. Your provider will watch your infection to see if it getting worse. He or she will also watch to see if you have any liver damage. Sometimes the medicines must be taken for years.

What Is The Purpose Of A Hepatitis B Test

Hepatitis B test is performed to detect, classify, and treat hepatitis B virus infection.

Hepatitis B blood tests involve the measurement of several HBV-specific antigens and antibodies. In addition, HBV blood tests also include liver enzymes and liver function tests to assess and monitor the condition of the liver and provide appropriate treatment.

The HBV specific tests include the following:

  • HBsAg: HBsAg is an antigen found on the surface of hepatitis B virus. HBsAg may be detected in the blood any time after 1 week post-exposure to HB virus, but usually appears after 4 weeks.
  • Anti-HBs: Anti-HBs are antibodies produced by the bodys immune system to fight HBsAg. Anti-HBs from a prior infection or vaccination provides immunity against further infection.
  • Hepatitis B core antigen : HBcAg is an antigen found in the core layer which covers the hepatitis B viral DNA.
  • Hepatitis B core antibody : Anti-HBc is the antibody that fights HBcAg. Anti-HBc is the first detectable antibody after HBV infection. There are two kinds of Anti-HBc:
  • Immunoglobulin M hepatitis B core antibody : IgM anti-HBc indicates acute or reactivated recent infection within the previous 6 months.
  • Immunoglobulin G hepatitis B core antibody : IgG anti-HBc may indicate previous or chronic infection. Once present, IgG anti-HBc persists for a lifetime.
  • HBV DNA: HBV DNA is the genetic material of the HB virus and this test is a measure of the actual viral load and replication.
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    What Is The Outlook For People With Hepatitis B

    The outlook for people with HBV is better now than ever before. You are certainly able to live a full life and help yourself stay healthy. You should make sure to have regular check-ups with a healthcare provider who is qualified to treat hepatitis B, possibly a liver doctor.

    Make sure you are vaccinated against hepatitis A. Check with your healthcare provider or pharmacist before taking other medications or over-the-counter products, including supplements and natural products. These could interfere with your medication or damage your liver. For instance, taking acetaminophen in large doses may harm your liver.

    Follow the usual guidelines for living a healthy life:

    • Eat nutritious foods, choosing from a variety of vegetables, fruits and healthy proteins. It is said that cruciferous vegetables are especially good at protecting the liver.
    • Exercise regularly.
    • Dont smoke and dont drink. Both tobacco and alcohol are bad for your liver.
    • Do things that help you cope with stress, like journaling, talking with others, meditating and doing yoga.
    • Avoid inhaling toxic fumes.

    How Common Is Hepatitis B

    Treatment of Hepatitis B 2019: Easy to Treat, Hard to Understand!

    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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    Symptoms Of Hepatitis B

    Some people who are infected with the hepatitis B virus have mild, flu-like symptoms and some do not become sick at all. Children who are infected are less likely to have an illness or get sick after getting hepatitis B than adults.

    In more severe cases, hepatitis B can cause:

    • Loss of appetite.
    • Pain in the joints.
    • Jaundice .

    Normally, these health problems disappear in a few weeks, but even when the person feels much better, they may still be infectious.

    Most adults who become infected with the hepatitis B virus recover completely and do not become infected again. A few people become very ill in the time just after infection and need to go to hospital some may even die.

    What Are The Types Of Hepatitis B

    There are two types of hepatitis B infection: acute and chronic.

    Acute

    An acute infection happens at the beginning, when you first get infected with hepatitis B. Many people are able to clear it from their bodies and recover. In fact, this is true of about 4 in 5 adults who are infected.

    Chronic

    If you are not able to clear the infection within six months or longer, you have chronic hepatitis B. It is chronic hepatitis B that leads to inflammation and the serious, and possibly fatal, illnesses of cirrhosis of the liver and liver cancer. Treatment can slow disease progress, reduce the chance of liver cancer and increase your chances of surviving.

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    Detection Of Antiviral Resistance

    Lamivudine monotherapy has been reported to be associated with the rapid emergence of antiviral resistance in 15% to 60% of treated individuals . Resistant HBV genomes have mutations in codon 552 within the YMDD motif of the reverse transcriptase/polymerase where a valine or isoleucine replaces the methionine. Resistance is typically clinically manifested by significant elevations in ALT after an initial decline in response to treatment. Prolonged treatment after development of the YMDD mutant is controversial, although improvement in liver pathology with decreased fibrosis may occur with continuation of treatment. Concerns about disease flares after stopping lamivudine have been raised . The development of genotypic resistance can be documented by molecular sequencing or by the INNO-LiPA HBV DR assay , which involves hybridization of amplified HBV-DNA fragments onto specific nucleotide probes that have been immobilized on nitrocellulose strips .

    Who Is Likely To Be A Hepatitis B Carrier

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    People living with chronic hepatitis B can be carriers. Often, carriers do not have symptoms. This means that they may unknowingly transmit the virus to others.

    However, within the U.S., there is a low rate of hepatitis B infections, which means that there is a small number of carriers. To prevent transmission, people can receive the hepatitis B vaccine.

    A person living with chronic hepatitis B who is an asymptomatic carrier can still spread the virus to others.

    The ways to transmit the infection include:

    • having genital contact with others
    • sharing needles

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    What Is The Difference Between Hepatitis B Surface Antibody And Antigen

    An antigen is a substance that induces antibody production. Hepatitis B surface antigen is a protein on the surface of hepatitis B virus.

    Hepatitis B surface antibodies are produced by the bodys immune system in response to HBsAg. The presence of adequate hepatitis B surface antibodies in the blood indicates protection against hepatitis B virus infection.

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    When To Get Tested

    When you have risk factors for HBV infection or when you have signs and symptoms of hepatitis, such as jaundice or unexplained elevated blood levels of alanine aminotransferase , a liver-associated enzyme when you have a condition that requires chemotherapy or drugs that suppress your immune system when you are being treated for HBV or hepatitis C when it is unclear whether you have immunity and your healthcare practitioner is considering giving you the hepatitis B vaccine

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    Living With Hepatitis B

    If you have hepatitis, you should:

    • avoid having unprotected sex, including anal and oral sex, unless you’re sure your partner has been vaccinated against hepatitis B
    • avoid sharing needles used to inject drugs with other people
    • take precautions to avoid the spread of infection, such as not sharing toothbrushes or razors with other people
    • eat a generally healthy, balanced diet there’s no special diet for people with hepatitis B
    • avoid drinking alcohol this can increase your risk of developing serious liver problems
    • speak to your doctor if you’re thinking of having a baby

    People with hepatitis B can usually have a healthy pregnancy, but it’s a good idea to discuss your plans with a doctor first as you may need extra care and your medications may need to be changed.

    There’s a risk of pregnant women with hepatitis B passing the infection on to their child around the time of the birth, but this risk can be reduced by ensuring the baby is vaccinated shortly after they’re born.

    Page last reviewed: 30 January 2019 Next review due: 30 January 2022

    How Can Hepatitis B Be Treated

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    Treatment for acute hepatitis is primarily supportive care. There are no specific medications that cure Hepatitis B.

    Bed rest is recommended during the acute phase of the disease when the symptoms are most severe. However patients are not adviced to be restricted to an absolute bed rest and confine to bed all the time. Moderate activity is allowed. Heavy physical work is not allowed.

    A good nutritious diet with plenty of fluids is recommended. There are no severe dietary restrictions.

    Some patients may respond to alpha interferon therapy.

    Other promising treatment options for chronic hepatitis B includenucleoside analogue drugs.

    People with liver cirrhosis are sometimes given a liver transplant.

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    Blood Tests To Check For Liver Damage

    Blood tests may be done to help find out if your liver has been damaged. They include:

    Future Of Hbv Treatment

    The availability of a simple, safe, and highly effective cure for hepatitis C has reenergized the search for a cure for hepatitis B. However, as described earlier, a sterilizing cure with elimination of both cccDNA and integrated HBV DNA may not be possible. Instead, experts agree that a functional cure akin to spontaneous HBsAg loss in patients with chronic HBV infection may be a realistic goal.3 The endpoint would be HBsAg loss accompanied by HBeAg loss and undetectable HBV DNA in serum, but HBV DNA may persist in the liver as integrated HBV DNA and as transcriptionally inactive cccDNA. Progression of liver disease would be halted, and over time fibrosis would regress and the incidence of HCC would decrease. Whether seroconversion to hepatitis B surface antibody is necessary to prevent HBsAg seroreversion remains to be determined. This functional cure is currently achievable in a small percentage of patients after IFN or NA therapy. The vision for the future is to deploy a combination of antiviral drugs directed against new targets and immunomodulatory therapies to restore innate as well as adaptive immune responses with the goal of achieving HBsAg loss in a higher percentage of patients after a finite course of treatment. These new strategies may or may not include IFN or NAs.

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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.

    World Health Organization Recommendations

    CCO Hep B Consult â HBV Treatment Guidelines

    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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