What Should You Know About Pregnancy And Hepatitis B
A pregnant woman who has hepatitis B can pass the infection to her baby at delivery. This is true for both vaginal and cesarean deliveries.
You should ask your healthcare provider to test you for hepatitis B when you find out you are pregnant. However, while it is important for you and your healthcare provider to know if you do have hepatitis B, the condition should not affect the way that your pregnancy progresses.
If you do test positive, your provider may suggest that you contact another healthcare provider, a liver doctor, who is skilled in managing people with hepatitis B infections. You may have a high viral load and may need treatment during the last 3 months of your pregnancy. A viral load is the term for how much of the infection you have inside of you.
You can prevent your infant from getting hepatitis B infection by making sure that your baby gets the hepatitis B vaccine in the hours after they are born along with the hepatitis B immunoglobulin. These two shots are given in two different locations on the baby. They are the first shots needed.
Depending on the type of vaccine used, two or three more doses must be given, usually when the baby is 1 month old and then 6 months old, with the last by the time the baby is 1 year old. It is critical that all newborns get the hepatitis B vaccination, but even more important if you have hepatitis B yourself.
What Will I Need To Do If I Am On Hepatitis B Medications
- Take oral medications every day to avoid developing resistance.
- See your provider on a regular basis
- If you have cirrhosis or high risk of liver cancer, get liver imaging on time as prescribed by your provider
- Have periodic laboratory tests to monitor HBV viral load and liver enzymes to monitor disease activity and response to medications
- You may need blood tests every 3-6 months initially and at least once a year thereafter if virus is undetected in blood.
Hepatitis B During Pregnancy
If a woman with HBV becomes pregnant, they may transmit the virus to their baby. Women should inform the doctor who delivers their baby that they have HBV.
The infant should receive an HBV vaccine and HBIG with 1224 hours of birth. This significantly reduces the risk that they will develop HBV.
The HBV vaccine is safe to receive while pregnant.
People with a high risk of HBV include:
- the infants of mothers with HBV
- the sexual partners of people with HBV
- people who engage in sexual intercourse without contraception and those who have multiple sexual partners
- men who have sex with men
- people who inject illicit drugs
- those who share a household with a person who has a chronic HBV infection
- healthcare and public safety workers who are at risk of occupational exposure to blood or contaminated bodily fluids
- people receiving hemodialysis, which is a type of kidney treatment
- people taking medications that suppress the immune system, such as chemotherapy for cancer
- those who come from a region with a high incidence of HBV
- all women during pregnancy
People can prevent HBV infection by:
- wearing appropriate protective equipment when working in healthcare settings or dealing with medical emergencies
- not sharing needles
- following safe sexual practices
- cleaning any blood spills or dried blood with gloved hands using a 1:10 dilution of one part household bleach to 10 parts water
A vaccine against HBV has been available since 1982.
People who should receive this vaccine include:
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How Do I Get Hepatitis B Treatment
Usually for adults, hepatitis B goes away on its own and you wont need treatment. Your doctor might tell you to rest, eat well, and get plenty of fluids. You may also get medicines to help with any symptoms you might have but be sure to talk with your doctor or nurse before taking anything.
If you have chronic hepatitis, there are medicines you can take to treat it. Your doctor will tell you about your options and help you get whatever treatment you need.
Hepatitis B Vs Hepatitis C
Hepatitis has many different types. HBV and the hepatitis C virus have both acute and chronic forms.
The main difference between HBV and HCV is how they spread from person to person. Although HCV is transmissible via sexual activity, this is rare. HCV usually spreads when blood that carries the virus comes into contact with blood that does not.
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Can Hepatitis B Be Treated
If you know you have been exposed to the hepatitis B virus in the previous seven days or less, you can receive an injection of hepatitis B immune globulin that may prevent you from developing the disease. Besides this, there is no treatment for acute hepatitis B.
If you have chronic hepatitis B, two types of treatment exist interferon which is a medication administered by a needle, and antiviral medicines that are taken by mouth. Current approved hepatitis B oral medications include lamivudine, adefovir, telbivudine, tenofovir, and entecavir. These treatments do not provide a cure, but they offer control of the virus so that further damage to your liver can be prevented. When and how to treat your hepatitis B is a decision between you and your doctor. Availability of the medications listed above may vary from province to province based on provincial government drug plans and individual insurance plans.
Progression Of Hepatitis B Treatment
Currently, six treatments are approved for hepatitis B, including interferon and five nucleotide/nucleoside analogues . The aim of hepatitis B treatment is to achieve sustained viral suppression of HBV replication. With viral suppression, the ultimate goal would be prevention of cirrhosis and HCC. Response to treatment is judged based on decrease in serum HBV DNA level, loss of HBeAg with or without seroconversion to antiHBe, loss of hepatitis B surface antigen with or without seroconversion to HBs antibody, normalization of serum ALT levels, and a decrease in hepatic inflammation on liver biopsy.
Characteristics of approved drugs for treatment of hepatitis B.
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Treating Chronic Hepatitis B
Some people with hepatitis B develop a chronic, incurable infection. Affected infants are at particularly high risk. If you have chronic hepatitis B, your health care provider might recommend you take medications to prevent liver damage. These medications fall into two classes:
- Immune modulators, which help boost the immune system to fight the effects of the virus. You would receive this medication as a series of shots over six months to one year.
- Antivirals, which help prevent the virus from reproducing in your body and causing as much inflammation and damage. You would take these as a daily pill for at least a year.
Not every person with hepatitis B is a good candidate for medication. Your medical provider should monitor you regularly for signs of liver disease and determine whether you need treatment.
Antiviral Medication For Hepatitis C
For people with hepatitis C, the goal of treatment with antiviral medication is to prevent the virus from replicating, or copying itself, and to eliminate the virus from the bloodstream. If the hepatitis C virus has been in the body for more than six months, the infection is considered chronic. Without treatment, most people with acute hepatitis C develop the chronic form of the disease.
Your doctor decides which antiviral medicationor combination of medicationsto prescribe based on the results of a blood test called a genotype test. There are six genotypes, or strains, of the hepatitis C virus, and people with certain genotypes respond more quickly to medical treatment.
For many years, the standard treatment for chronic hepatitis C consisted of the antiviral medications pegylated interferon and ribavirin. Ribavirin is taken by mouth every day, and interferon is an injection that you or a caregiver can administer once a week at home.
In 2013 and 2014, the U.S. Food and Drug Administration approved a group of new medications for the treatment of hepatitis C. These medications, which include sofosbuvir, are very effective and have fewer side effects than older medications, particularly interferon.
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Role Of Antivirals In Prevention Of Hcc Recurrence
With the advent of antiviral therapy, it is now possible to reduce inflammation, regress cirrhosis and reduce the incidence of HCC in patients with CHB. The incidence of HCC recurrence after resection of HBV-related HCC is high. Newer data has shown that there is a role for antiviral therapy for those who have already developed HCC. Since 2005, there have been retrospective studies, small and large in numbers that showed improvement of survival in patients who received concomitant antiviral therapy after curative liver resection and local tumor ablation. Treatment with nucleoside/nucleotide analogues may prevent de novo primary tumors and further progression of liver disease, thereby decreasing recurrent HCC. Recent large cohort studies further confirmed the benefit of antiviral therapy in this group of patients with decrease in mortality with the antiviral treatment. The longest survivors of those who benefited from antiviral therapy following the existing tumor ablation have reached over 12 years . This novel treatment strategy may offer a significant alternative to liver transplantation to relieve the current graft shortage.
Important Questions And Needs For Future Research
How does HBV establish productive infection in vivo and what is the host response early during the infection? Despite well-described information on the clinical manifestations and natural history of acute HBV infection, detailed knowledge of the virus-host interaction during this stage remains poorly defined. Advances in this area would offer a better understanding of the pathogenesis of HBV infection and its associated disease.
What is the immunologic basis of chronic infection and hepatocellular injury? There have been great strides in understanding the virology and immune response of HBV infection, but the molecular mechanisms whereby the host fails to clear the virus and develops chronic infection remain largely unknown. In addition, the adaptive evolution of virus under host immune pressure remains to be elucidated. Finally, the pathogenesis of various extra-hepatic manifestations associated with HBV infection is poorly understood. Further research in these areas is crucial not only in better understanding the natural history and disease progression but also in improving treatment for chronic hepatitis B.
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Is There A Cure For Chronic Hepatitis B
Currently, there is no complete cure for hepatitis B. But when managed properly, those living with the virus can expect to live a normal life. Maintaining a healthy diet and avoiding alcoholic beverages and tobacco products are crucial components in managing the disease.
You should also visit a doctor familiar with hepatitis B at least annuallythough twice a year might be best to monitor your liver through blood tests and medical imaging. As with most diseases, detecting it early leads to a better outcome. If youre exposed to the virus, you should get an antibody injection within 12 hours of exposure.
How Is Hepatitis B Treated
Your healthcare provider will treat you based on what type of hepatitis B you have, acute or chronic.
Acute hepatitis B infections
If you develop an acute form of the condition, you probably wont need medical treatment. Instead, your doctor will likely suggest that you get plenty of rest, drink lots of fluids and maintain a healthy diet to support your body as it fights off the infection.
Chronic hepatitis B infections
If you have chronic hepatitis B, you might be a candidate for drug therapy. Usually, drug therapy is used only if you have active liver disease. There are seven drugs that are approved by the U.S. Food and Drug Administration to treat hepatitis B. Two are injectable forms of interferon, while the five other antivirals are tablets.
You will need to take these medications every day. They help by slowing the viruss ability to multiply in your system. This helps reduce swelling and liver damage. Youll need to be regularly monitored for early signs of liver damage and liver cancer. Your healthcare provider will want to see you once or twice a year.
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What Is Involved In A Liver Transplant
A liver transplant is considered necessary when the liver is damaged and cannot function or in some cases of liver cancer. Your liver is very important. It is responsible for many functions related to making sure that your body stays healthy and is able to digest foods.
You may be eligible for a transplant if you have chronic hepatitis B infection or some of the diseases that may result from it, including liver cancer and cirrhosis. You will have to complete testing and be evaluated before being approved for a transplant. It is likely that you will be placed on a waiting list while an appropriate organ is found.
Donated livers come from two types of donors: living and deceased. Because the liver can regenerate, it is possible to use part of a liver for transplant. The remaining sections in both the donor and the receiver will grow into livers of adequate size.
People who get liver transplants must take anti-rejection drugs for the rest of their lives. These drugs make you more susceptible to infection. However, liver transplants have become more successful over time and continue to improve.
Who Is At Risk For Hepatitis B
Anyone can get hepatitis B, but the risk is higher in:
- Infants born to mothers who have hepatitis B
- People who inject drugs or share needles, syringes, and other types of drug equipment
- Sex partners of people with hepatitis B, especially if they are not using latex or polyurethane condoms during sex
- Men who have sex with men
- People who live with someone who has hepatitis B, especially if they use the same razor, toothbrush, or nail clippers
- Health care and public-safety workers who are exposed to blood on the job
If you have chronic hepatitis B, you may not have symptoms until complications develop. This could be decades after you were infected. For this reason, hepatitis B screening is important, even if you have no symptoms. Screening means that you are tested for a disease even though you don’t have symptoms. If you are at high risk, your health care provider may suggest screening.
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Hepatitis B: Symptoms Causes And Treatment Options
Hepatitis B refers to the inflammation of the liver, often caused by a viral infection. However, there are many other possible causes of hepatitis. These include hepatitis caused by secondary results of drugs, medications, alcohol, and toxin. If a person’s body makes antibodies against the liver tissue, it can also lead to autoimmune hepatitis.
According to an estimate by the WHO, over 356 million people worldwide currently live with chronic hepatitis. Most adults suffer from acute hepatitis B, which lasts a short time. However, CDC reveals that about 3-7% of people develop a chronic infection that can cause liver failure, cancer, and scarring of the organ, which can be life-threatening, especially for those with compromised immune systems.
American Association For The Study Of Liver Diseases Recommendations
The 2016 AASLD guidelines for the treatment of chronic hepatitis B as well as select recommendations from the 2018 AASLD guidance update on the prevention, diagnosis, and treatment of chronic hepatitis B are outlined below and in the Guidelines section.
Adults with immune-active chronic hepatitis B infection
Administer antiviral therapy to lower the risk of morbidity and mortality associated with chronic hepatitis B infection.
The recommended initial agent for adults is PEG-IFN, entecavir, or tenofovir.
Adults with immune-tolerant chronic hepatitis B infection
Antiviral therapy is not recommended.
The AASLD suggests obtaining ALT levels at least every 6 months to monitor for potential transition to immune-active or -inactive chronic hepatitis B.
For select patients older than 40 years, the AASLD suggests antiviral therapy in the setting of normal ALT levels, elevated HBV DNA , and significant necroinflammation or fibrosis on liver biopsy specimens.
Adults with HBeAg-positive immune-active chronic hepatitis B who seroconvert to anti-HBe on nucleoside analog therapy
After a period of treatment consolidation , consider discontinuing NA therapy in noncirrhotic HBeAg-positive adults who seroconvert to anti-HBe while on NA treatment. If antiviral therapy is stopped, monitor the patient every 3 months for a minimum of 1 year for recurrent viremia, ALT flares, seroreversion, and clinical decompensation.
Adults with HBeAg-negative immune-active chronic HBV infection
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World Health Organization Recommendations
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 . ]
Symptoms To Look Out For
HBV infections can occur even during infancy, as mothers can pass the HBV to their child during childbirth. Symptoms of the infection are typically dont appear in children under five years of age, but the disease can often go undiagnosed even in adults with a suppressed immune system. Moreover, there’s a vaccine to prevent newborns from becoming infected.
Acute symptoms start appearing 50-150 days after the exposure. These symptoms can last from several weeks to six months. A person suffering from chronic HBV may experience ongoing episodes of aching joints, abdominal pains, persistent fatigue, fever, nausea, loss of appetite, and vomiting. Dark urine, clay or light-colored poop, and jaundice are also among the alarming signs. Interestingly, only one-third of people who catch the virus don’t feel any symptoms. The only way to determine if they have Hepatitis B is through a blood test.
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