Who Are Hepatitis B Carriers
Hepatitis B carriers are people who have the hepatitis B virus in their blood, even though they dont feel sick. Between 6% and 10% of those people whove been infected with the virus will become carriers and can infect others without knowing it. There are over 250 million people in the world who are carriers of HBV, with about 10% to 15% of the total located in India. Children are at the highest risk of becoming carriers. About 9 in 10 babies infected at birth become HBV carriers, and about half of children who are infected between birth and age 5 carry the virus. A blood test can tell you if you are a hepatitis B carrier.
What Are The Types Of Hepatitis B
There are two types of hepatitis B infection: acute and chronic.
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.
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.
What Exactly Is Hepatitis B
However, it cannot be spread to others by sneezing or coughing. Hepatitis B causes liver inflammation that can if it persists cause lasting liver damage.
For many people, hepatitis B is a short-term illness that goes away on its own after some time. For others, however, it can become a chronic condition.
Younger people, especially infants and children below the age of five, who are infected by HBV have a much higher risk of developing chronic hepatitis B.
People from certain regions in the world also carry a higher risk of developing chronic hepatitis B, including persons from Sub-Saharan Africa, the Pacific islands, the Middle East, as well as parts of Northeast and Southeast Asia.
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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.
Current Antiviral Drugs Against Hbv
Currently, two different therapeutic strategies have been approved to treat CHB patients. These included IFN- or Peg-IFN- and direct-acting antivirals comprised of NAs that include nucleoside analogs, lamivudine , telbivudine and entecavir , or NAs adefovir dipivoxil and tenofovir disoproxil fumarate .
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New Treatment Principle For Chronic Hepatitis B And D Infections
- Karolinska Institutet
- A new immunological treatment against hepatitis B and D viruses, both of which can cause liver cancer, shows promising results in animal models.
A new immunological treatment against hepatitis B and D viruses, both of which can cause liver cancer, shows promising results in animal models. Results from the treatment, which is being developed by researchers at Karolinska Institutet in Sweden, have been published in the journal Gut.
Chronic infections of the hepatitis B virus and hepatitis D virus are major causes of severe liver damage and liver cancer.
A vaccine against hepatitis B exists, but over 250 million people currently have chronic infections. The available treatment rarely leads to the complete disappearance of the infection, which means that the risk of liver damage remains. Current treatment for chronic hepatitis D infection only cures about a quarter of patients.
That is why researchers at Karolinska Institutet are developing a new type of treatment that will hopefully provide a lasting treatment response against both viruses.
The treatment consists of two components designed to affect the immune system in different ways. First, a DNA-based vaccine is administered that activates the production of neutralising antibodies and T-cells against both viruses. Then, repeated doses of a protein-based vaccine are given to reinforce the activation of the immune system.
Issued: 25 June 2022 London Uk
- Interim analysis from the B-Clear phase IIb trial shows bepirovirsens potential to suppress both the surface antigen and the virus of hepatitis B, leading to the possibility of functional cure
- Phase III trial evaluating bepirovirsen as a monotherapy is anticipated to start in the first half of 2023
- Exploring potential combination treatments to further reduce the global burden of chronic hepatitis B
GSK plc today announced promising interim results from the B-Clear phase IIb trial showing that bepirovirsen, an investigational antisense oligonucleotide treatment for hepatitis B, reduced levels of hepatitis B surface antigen and hepatitis B virus DNA after 24 weeks treatment in people with chronic hepatitis B .
These interim analysis data were presented today in an oral late-breaker session at the European Association for the Study of the Livers International Liver Congress 2022 in London, UK. The final results from the study will be submitted for presentation at a scientific congress later this year, and for publication in a peer-reviewed journal.
Chris Corsico, SVP, Development, GSK, said: Chronic hepatitis B affects nearly 300 million people with approximately 900,000 patients dying each year from its associated complications., These encouraging data support further investigation of bepirovirsen, both as monotherapy and in combination, as a potentially transformative new treatment option for patients with chronic hepatitis B.
About the B-Clear phase IIb trial
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Bepirovirsen Shows Positive Results In The Treatment Of Chronic Hepatitis B
Bepirovirsen produced sustained clearance of hepatitis B virus and hepatitis B surface antigens.
Bepirovirsen , an investigational antisense oligonucleotide, produced sustained clearance of hepatitis B virus and hepatitis B surface antigens in patients on concurrent nucleoside/nucleotide analogues and in patients not-on-NA therapy, according to results from the B-Clear phase 2B trial.
The trial found potential in bepirovirsen as a potential monotherapy or in combination with NAs, which could result in functional cure, according to GSK. Additionally, the trial identified a potential patient subgroup who are more likely to benefit from treatment with bepirovirsen.
results from the B-Clear study are a promising step forward for the approximately 300 million people living with chronic hepatitis B, said Chris Corsico, SVP, Development, GSK, in a press release. We look forward to confirming these findings for bepirovirsen in our phase 3 study starting next year, as well as exploring potential sequential therapy options with the aim of helping more people living with achieve functional cure.
Patients with low baseline HBV surface antigen levels had the best response to treatment with bepirovirsen in treatment arm 1, with 16% of patients on NA and 25% of patients not on NA achieving the primary endpoint.
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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Can Hepatitis B Be Prevented
The hepatitis B vaccine is one of the best ways to control the disease. It is safe, effective and widely available. More than one billion doses of the vaccine have been administered globally since 1982. The World Health Organization says the vaccine is 98-100% effective in guarding against the virus. Newborns should be vaccinated.
The disease has also been more widely prevented thanks to:
- Widespread global adoption of safe blood-handling practices. WHO says 97% of the blood donated around the world is now screened for HBV and other diseases.
- Safer blood injection practices, using clean needles.
- Safe-sex practices.
You can help prevent hepatitis B infections by:
- Practicing safe sex .
- Never sharing personal care items like toothbrushes or razors.
- Getting tattoos or piercings only at shops that employ safe hygiene practices.
- Not sharing needles to use drugs.
- Asking your healthcare provider for blood tests to determine if you have HBV or if you are immune.
Hepatitis B Symptoms And Treatment
Hepatitis B is part of a group of hepatitis viruses that attack the liver. It is spread through blood and bodily fluids. It is most commonly passed on via unprotected sex , from a mother to her child during birth, or through contaminated needles.
In adults, it often causes no obvious symptoms and can pass in a few months without treatment. Children are more likely to develop a long-lasting infection. Without appropriate treatment and care, children and adults with a chronic infection can become seriously ill and be at risk of liver damage or death.
Vaccines for hepatitis B are offered to infants and are available for people at high risk of the condition.
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Should All Patients With Chronic Hepatitis B Be On Treatment
Not all patients with chronic hepatitis B need to be on treatment. The decision to treat HBV is based on several factors including blood tests results, the patient’s age, and the risk of developing cirrhosis or liver cancer. Sometimes a liver biopsy is needed to see if there is significant liver damage to make a decision.
Hepatitis B medications are recommended for patients with detected HBV virus on a blood test and evidence of liver damage. Liver damage can be detected with a liver enzyme known as ALT. People with cirrhosis should be considered for treatment even if the liver enzymes appear normal.
Chronic hepatitis B may change over time. Patients can go through different phases with low amounts of virus and normal level of ALT followed by high viral loads and ALT levels. These bursts of virus activity usually don’t cause any symptoms but may cause liver damage overtime. It is important that people with chronic hepatitis B have blood tests on a regular basis to see if treatment is needed.
There are some medications which can cause hepatitis B “reactivation” which can lead to life threatening liver failure. These medications are used to treat some cancers, inflammatory conditions and hepatitis C. Reactivation reactions can be prevented and it is important to let your provider know you have HBV before you start any new medications.
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.
The AASLD does not recommend antiviral therapy 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 . ]
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
Adults with HBeAg-negative immune-active chronic HBV infection
Children with chronic hepatitis B infection
Individuals with HBV and HCV coinfection
Individuals with HBV and HIV coinfection
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Combination Of Na Plus Peg
Although the current monotherapy of anti-HBV drugs can suppress viral replication, prevent the progression of CHB to cirrhosis, and decrease the rates of HBV-related HCC in most CHB patients, long-term anti-HBV monotherapy rarely achieves the higher rate of HBsAg loss. Hence, to accomplish the goal of a functional cure in more CHB patients, the combination of NA with Peg-IFN- has been evaluated. The reason for this is that the two classes of anti-HBV drugs have different mechanisms of action. Thus, their combination would result in a synergistic anti-HBV effect. Several studies have demonstrated that the combination of NA with Peg-IFN- can substantially enhance the rates of HBsAg loss, but the benefits are mainly limited to a small proportion of patients and depend on HBV genotype and patient geographical distributions. Moreover, NAs and Peg-IFN- treatment have no direct impact on viral transcription or cccDNA. Thus, there is a very high risk of reactivation of HBV and the emergence of downstream disease symptoms after stopping treatment. Therefore, new therapeutic drugs that target different HBV life cycle steps or modulate the host immune system are needed.
What Are The Risk Factors For Getting Hepatitis B
Due to the way that hepatitis B spreads, people most at risk for getting infected include:
- Children whose mothers have been infected with hepatitis B.
- Children who have been adopted from countries with high rates of hepatitis B infection.
- People who have unprotected sex and/or have been diagnosed with a sexually transmitted infection.
- People who live with or work in an institutional setting, such as prisons or group homes.
- Healthcare providers and first responders.
- People who share needles or syringes.
- People who live in close quarters with a person with chronic hepatitis B infection.
- People who are on dialysis.
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What Are The Treatments For Hepatitis B
If you think you may have been exposed to hepatitis B, its important to talk with a healthcare professional as soon as possible.
A doctor or other healthcare professional may administer the first dose of the hepatitis B vaccine and a shot of hepatitis B immunoglobulin. This is a combination of antibodies that provide short-term protection against the virus.
Though both can be given up to a week after exposure, theyre most effective at preventing infection if administered within 48 hours.
If you receive a diagnosis of acute hepatitis B, a doctor may refer you to a specialist. They may advise you to get regular blood tests to ensure you dont develop chronic hepatitis.
Many people with acute hepatitis B dont experience serious symptoms. But if you do, it can help to:
- get plenty of rest
- take over-the-counter pain mediation, like naproxen, when needed
Other lifestyle changes may also be needed to manage your infection, such as:
- eating a nutritious, balanced diet
- avoiding substances that can harm your liver, such as:
- certain herbal supplements or medications, including acetaminophen
If blood tests show you still have an active infection after 6 months, your doctor may recommend further treatment, including medications to help control the virus and prevent liver damage.
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Incomplete Or Failed Response To Treatment
Some people with autoimmune hepatitis have an incomplete response to treatment, meaning that treatment helps but does not lead to remission. If you have an incomplete response to treatment, you may need to take different medicines to help prevent liver damage.
Some people may fail to respond to treatment, meaning that the inflammation and liver damage of autoimmune hepatitis keep getting worse. Your doctor may recommend additional blood tests and higher doses of medicines. If liver damage leads to complications, you may need treatment for complications.
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How You Can Get Hepatitis B
You can get hepatitis B from:
- injecting drugs using shared needles
- being injured by a used needle
- having a tattoo or piercing with unsterilised equipment
- having a blood transfusion in a country that does not check blood for hepatitis B. Blood transfusions in the UK are checked for hepatitis B.
If youre pregnant and have hepatitis B, you can also pass it onto your baby during pregnancy or birth.