Monday, January 30, 2023

Treatment Options For Hepatitis B

Injections: Interferon And Pegylated Interferon

Chronic Hepatitis B: Treatment Indications and Options (2/3)

Pegylated interferon is given as an injection once per week. It can be used alone or with an oral hepatitis B medication. Patients with both chronic hepatitis B and hepatitis D infection may need pegylated interferon alone or combined with an oral hepatitis B pill.

  • Pegylated interferon therapy is usually given for 48 weeks.
  • Pegylated interferon may cause many side effects, such as flu-like symptoms, rashes, irritability, and depression.
  • Side effects to interferon require close monitoring with routine blood tests.

Is There A Cure For Hepatitis B

The long and short answer is that there is not yet a cure for hepatitis B. Understanding why requires insight into the virus itself and the challenges cure researchers face.

Hepatitis B is an infectious disease caused by the hepatitis B virus . While most people exposed to hepatitis B will spontaneously clear the virus soon after infection, a proportion will go on to develop a chronic infection.

Of these, around one in four will develop severe liver complications, including cirrhosis and liver cancer, typically years after the initial infection.

Efforts to find a cure for hepatitis B have been underway since the virus was first identified by scientists at the National Institutes of Health in 1966. It soon became clear, however, that numerous hurdles would need to be overcome before an actual cure could be achieved. Chief among these are:

Characteristics Of And Current Treatment Optionsfor Hepatitis B And Hepatitis C

Paul Adams, MD, FRCP

Patients with hepatitis B andhepatitis C pose risks to health care workers, including dental professionals. Thisarticle provides information about the natural history, current treatment options andfuture directions of therapy for these 2 forms of hepatitis.

Hepatitis B

Not all patients who test positive for hepatitis B surface antigen require antiviral therapy. Many people have circulating HBsAg without evidence ofsignificant hepatitis. These people are called chronic carriers and account for themajority of hepatitis B cases. The terms chronic carriers and hepatitispatients are thus somewhat misleading, given that there is a spectrum of disease.

Appropriate clinical assessment includes history and physical examination, blood tests,abdominal ultrasonography, and often liver biopsy. A typical patient for whom treatmentwould be considered appropriate tests positive for HBsAg and hepatitis B e antigen, has detectable levels of hepatitis B viral DNA and has elevated levels of alanineaminotransferase .

Treatment options include alpha interferon or oral lamivudine therapy . The goals of therapy are conversionfrom HBeAg-positive status to HBeAg-negative status and development of anti-HBeAgantibody. Unfortunately, these aims are achieved in only approximately 20% of cases witheither therapy.

Future directions for hepatitis B therapy include multidrug therapies, similar to thosefor HIV. Family contacts should undergo vaccination against hepatitis B virus.

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What Do I Need To Know About Having Hepatitis B

If you have chronic hepatitis B, getting the right medical care can help you stay healthy. Taking good care of your liver is important. Talk with your doctor before you take any prescription medication, over-the-counter drugs, vitamins, or nutritional supplements to make sure they wont hurt your liver. You should also stay away from alcohol, because drinking can damage your liver.

Unlikely Sources Of Infection

#VisualAbstract: Adjunctive methylprednisolone treatment for hepatitis ...

Trace levels of HBV can also be found in saliva, tears, urine, and feces but in amounts that are highly unlikely to cause infection.

While vaccination remains the cornerstone of HBV prevention, there are ways to further reduce the risk of transmission, especially if you or someone in your household has hepatitis B:

  • Wash your hands with soap and water if exposed to blood.
  • Avoid sharing razors or toothbrushes.
  • Use condoms during sex.

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Hepatitis B Surface Antigen Test

A hepatitis B surface antigen test shows if you have an active infection. A positive result means you have hepatitis B and can transmit the virus to others. A negative result means you dont currently have hepatitis B.

This test doesnt distinguish between chronic and acute infection. This test is used together with other hepatitis B tests to determine the state of a hepatitis B infection.

Whats The Prognosis For Hepatitis B

Your doctor will know youâve recovered when you no longer have symptoms and blood tests show:

  • Your liver is working normally.
  • You have hepatitis B surface antibody.

But some people don’t get rid of the infection. If you have it for more than 6 months, youâre whatâs called a carrier, even if you donât have symptoms. This means you can give the disease to someone else through:

  • Unprotected sex
  • Contact with your blood or an open sore
  • Sharing needles or syringes

Doctors donât know why, but the disease does go away in a small number of carriers. For others, it becomes whatâs known as chronic. That means you have an ongoing liver infection. It can lead to cirrhosis, or hardening of the organ. It scars over and stops working. Some people also get liver cancer.

If youâre a carrier or are infected with hepatitis B, donât donate blood, plasma, body organs, tissue, or sperm. Tell anyone you could infect — whether itâs a sex partner, your doctor, or your dentist — that you have it.

Show Sources

CDC: âHepatitis B Questions and Answers for Health Professionals,â âHepatitis B Questions and Answers for the Public.â

Mayo Clinic: âHepatitis B.â

UpToDate: âHepatitis B virus: Screening and diagnosis.â

CDC.

HealthyPeople.gov: âHepatitis B in Pregnant Women: Screening.â

Annals of Internal Medicine: âScreening for Hepatitis B Virus Infection in Nonpregnant Adolescents and Adults: U.S. Preventive Services Task Force Recommendation Statement.â

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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.

What Other Problems Can Hepatitis B Cause

CAR-T therapy, a novel promising treatment option for chronic hepatitis B and HBV-associated HCC

In rare cases, acute hepatitis B can cause liver failure.

Chronic hepatitis B can develop into a serious disease that causes long-term health problems such as cirrhosis , liver cancer, and liver failure.

If you have ever had hepatitis B, the virus may become active again, or reactivated, later in life. This could start to damage the liver and cause symptoms.

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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

Inpatient care

Antiviral Medication For Hepatitis B

Doctors may recommend antiviral medication for people with chronic hepatitis B, which occurs when the virus stays in your body for more than six months.

Antiviral medication prevents the virus from replicating, or creating copies of itself, and may prevent progressive liver damage. Currently available medications can treat hepatitis B with a low risk of serious side effects.

NYU Langone hepatologists and infectious disease specialists prescribe medication when they have determined that without treatment, the hepatitis B virus is very likely to damage the liver over time. People with chronic hepatitis B may need to take antiviral medication for the rest of their lives to prevent liver damage.

There are many different types of antiviral medications available, and your doctor recommends the right type for you based on your symptoms, your overall health, and the results of diagnostic tests. A doctor may take a wait-and-see approach with a person who has a healthy liver and whose blood tests indicate a low viral load, the number of copies of the hepatitis B virus in your bloodstream.

Someone with HIV infection or AIDS may have a weakened immune system and is therefore more likely to develop liver damage. The U.S. Centers for Disease Control and Prevention strongly recommends that people with HIV infection who are diagnosed with hepatitis B immediately begin treatment with antiviral medication.

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Hepatitis B And Pregnancy

Because their immune systems arent fully developed, infants and young children are more likely to develop chronic hepatitis B, so its important to limit their exposure to the virus. All expecting women should be screened for hepatitis B. If a high viral load is detected through testing, your doctor will initiate treatment during your third trimester to reduce the likelihood that your baby will contract the disease during delivery.

Additionally, the infants of mothers with hepatitis B should receive the hepatitis B vaccination series and immune globulins at birth so they do not develop hepatitis B.

Can Hepatitis B Be Prevented

Top Health Doctors

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 person’s 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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Is Hepatitis B Curable

Theres no cure for hepatitis B. The good news is it usually goes away by itself in 4 to 8 weeks. More than 9 out of 10 adults who get hepatitis B totally recover.

However, about 1 in 20 people who get hepatitis B as adults become carriers, which means they have a chronic hepatitis B infection. Carriers are more likely to pass hepatitis B to other people. Most carriers are contagious meaning they can spread hepatitis B for the rest of their lives.

Hepatitis B infections that last a long time may lead to serious liver diseases like cirrhosis and liver cancer. About 1 in 5 people with chronic hepatitis B die from it. There are medicines that can help treat chronic hepatitis B infections.

Most babies who get hepatitis B during birth develop chronic infection, unless they get treated right away. But treatments are almost always effective if your baby gets them quickly. Thats why its important for pregnant people to get tested for hepatitis B.

The Hepatitis B Vaccine

Getting the hepatitis B vaccine is one of the most effective ways to prevent hepatitis B. Its usually administered in two, three, or four doses. In many countries, infants receive their first dose of the vaccine at birth.

The Centers for Disease Control and Prevention recommends that infants receive their first dose of the vaccine at birth and finish all doses at 6 to 18 months old.

The CDC also recommends all children under the age of 19 years old be vaccinated if they havent already received the vaccination.

Adults can also get the hepatitis B vaccine. The vaccine is generally recommended if you have an increased risk of contracting the virus. Some of these risk factors include:

  • traveling to or living in a region where hepatitis B is common
  • being sexually active with more than one partner or with a partner who has hepatitis B
  • working in a medical setting or other workplaces where youre exposed to bodily fluids
  • using intravenous drugs and sharing drug equipment
  • having chronic liver disease, a human immunodeficiency virus infection, a hepatitis C infection, diabetes, or kidney disease on dialysis

If youve been exposed to the hepatitis B virus and havent been vaccinated, try to see a doctor right away. They can administer the first dose of the vaccine, though youll need to follow up to receive the remaining doses over the next few months.

They may also prescribe a medication called

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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.

How You Can Get Hepatitis B

Chronic Hepatitis B: Treatment Indications and Options (1/3)

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 you’re pregnant and have hepatitis B, you can also pass it onto your baby during pregnancy or birth.

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New And Current Treatment Options For Hepatitis B

The search for new treatments for hepatitis B has been ongoing for decades. While effective at suppressing the virus, current treatments, which include antivirals, cannot eliminate it from the liver.

Hepatitis B is a liver infection that results from the hepatitis B virus. People acquire it through contact with the bodily fluids of someone with the virus. The liver cleanses the body of waste, and the disruption to its processes can make a person seriously ill.

This article will outline the current treatment options for HBV. It will also discuss new treatments in development that may lead to a cure for HBV.

Initial infection with HBV is an acute infection. Most healthy people with infection with this virus will not have symptoms and can shed the virus easily. If tests show that a person still has the virus 6 months after contracting it, they have a chronic, long-term infection. Doctors use blood tests to diagnose and monitor the condition.

Treatment whether a person has acute or chronic hepatitis B.

Practical Management Of Drug Resistance

In cases of a confirmed virological breakthrough and exclusion of non-adherence , the patient should be either switched to another antiviral monotherapy with a high genetic barrier to resistance or a second antiviral drug with a complementary resistance profile should be added . Although it appears reasonable from a virological point to reduce resistance by combination therapy, there are no clear long-term data favoring the add-on over the switch concept . Table 2 summarizes current recommendations for the management of treatment failure.

Table 2

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