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 . ]
How Common Is Hepatitis B
Hepatitis B is fairly common in Africa and the western Pacific region. Throughout the world, there are about 292 million people who are infected with chronic hepatitis B. In the U.S., the figure exceeds 2 million people.
The number of infections had been falling in the U.S., but fewer vaccinations among adults combined with the onset of the opioid crisis and injected drug usage has resulted in the numbers rising again. Infected women can pass the infection on to their babies. Children who are infected before age 5 are more likely to have chronic infection than those infected later in life.
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.
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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.
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.
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Diagnosis Of Hepatitis B
Blood tests are available to determine if you are or have been infected with hepatitis B. It may take 6 months from the time of infection before a blood test can detect antibodies to hepatitis B, so follow-up testing may be required. During this 6-month period, until you know whether you are infected or not, take action to prevent potential infection of other people.
There are also tests that can assess liver damage from hepatitis B. The interpretation of these tests can be complicated and specialist advice is needed, so talk to your doctor.
All pregnant women are tested for hepatitis B. If you are found to have chronic hepatitis B, your doctor can help reduce the risk of transferring the infection to your newborn child.
Hepatitis B Virus/hiv Coinfection
Approximately 5% to 10% of people with HIV in the United States also have chronic hepatitis B virus infection.1 The progression of chronic HBV to cirrhosis, end-stage liver disease, or hepatocellular carcinoma is more rapid in persons with HBV/HIV coinfection than in persons with chronic HBV monoinfection.2 Conversely, chronic HBV does not substantially alter the progression of HIV infection and does not influence HIV suppression or CD4 T lymphocyte cell responses following initiation of antiretroviral therapy .3,4 However, antiretroviral drug toxicities or several liver-associated complications attributed to flares in HBV activity after initiation or discontinuation of dually active ARV drugs can affect the treatment of HIV in patients with HBV/HIV coinfection.5-7 These complications include the following:
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Treating Hepatitis B With Tenofovir
Violetta Shamilova, PharmD, is a board-licensed pharmacist. She is an assistant professor at the Touro College School of Health Sciences, and has worked at CVS pharmacy for five years. She completed the certified APhA Delivering Medication Therapy Management Services course.
Tenofovir, also called tenofovir disoproxil fumarate, is an antiviral drug for treating chronic hepatitis B in adults and children who are 12 years and older. It is also used, in combination with other drugs, to treat the human immunodeficiency virus or HIV. Its sold under the brand name Viread by Gilead Sciences, Inc.
What Other Problems Can Hepatitis B Cause
In rare cases, acute hepatitis B can cause 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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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.
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
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
Hepatitis B In The United States
In the United States, about 862,000 people have chronic hepatitis B.6 Asian Americans and African Americans have higher rates of chronic hepatitis B than other U.S. racial and ethnic groups.10 Researchers estimate that about half of the people living with chronic hepatitis B in the United States are Asian Americans and Pacific Islanders.11 Chronic hepatitis B is also more common among people born in other countries than among those born in the United States.7
The hepatitis B vaccine has been available since the 1980s and, in 1991, doctors began recommending that children in the United States receive the hepatitis B vaccine. The annual rate of acute hepatitis B infections went down 88.5 percent between 1982 and 2015.12 In 2017, the annual number of hepatitis B infections rose in some states.13 Experts think the rise was related to increases in injection drug use. Injection drug use increases the risk of hepatitis B infection.
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What Are The Post
The post treatment guidelines are very much mandatory when undergoing the medications. You need to make lots of changes to your lifestyle and in most cases your eating habits. Technically your care for your liver should double, and you might not want to indulge in any activity that can hamper your liver again. You have to ultimately curb your smoking and drinking activities and refrain from using drugs. Also, the medications have to be taken religiously and should never be skipped.
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Medical Treatment For Hepatitis A B & C
Treatment for hepatitis A, B, or C is based on which type of hepatitis is present in the bloodstream and the severity of the resulting liver damage. Depending on the results of diagnostic tests, our specialists at NYU Langone may recommend antiviral medication to stop the virus from replicating and protect your liver from further damage.
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Vaccination And Other Prevention Measures
Vaccination is a safe and effective way of preventing the spread of hepatitis B. Since 1985, the hepatitis B vaccine has been part of the national immunisation schedule. In 1988, New Zealand was one of the first countries to introduce universal infant hepatitis B immunisation.The vaccine is given to babies at age six weeks, three months, and five months. Babies born to mothers with hepatitis B receive an extra dose of the vaccine at birth as well as a dose of hepatitis B-specific immune globulin.In children and adolescents who did not receive the hepatitis B vaccine in the first year of life, the full three-dose course is recommended.Hepatitis B immunisation is recommended and publicly funded for all infants and children up to their 18th birthday, household and sexual contacts of people with acute or chronic hepatitis B, and certain other high-risk populations. Measures that can help prevent the spread of the hepatitis B virus include:
- Teaching children not to touch the blood or wounds of others
- Covering cuts, scratches, and grazes
- Not sharing personal items such as razors and toothbrushes
- Never sharing needles or syringes if you use intravenous drugs
- Practising safe sex, including the use of condoms
- Seek assurance that body piercing and tattooing needles and equipment are sterile.
Barriers To Eliminating Hbv
Persistence of cccDNA and its ability to self-replenish 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. 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.
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How Do Doctors Treat The Complications Of Hepatitis B
If chronic hepatitis B leads to cirrhosis, you should see a doctor who specializes in liver diseases. Doctors can treat the health problems related to cirrhosis with medicines, minor medical procedures, and surgery. If you have cirrhosis, you have an increased chance of liver cancer. Your doctor may order blood tests and an ultrasound or another type of imaging test to check for liver cancer.
If chronic hepatitis B leads to liver failure or liver cancer, you may need a liver transplant.
What Are The Symptoms Of Hepatitis B
People who develop Hep B may face different symptoms that can last for weeks. Some common symptoms are mild fever, stomach pain, loss of appetite, achy joints or muscles, brown urine, constipation, mild fever, and more. Jaundice or yellowing of eyes whites can also be a symptom of hep B. If you have such symptoms, then consult a doctor for evaluation.
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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.
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:
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.
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.
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Epidemiology Of Hdv Infection
HDV infection is a significant source of healthcare and economic burden. Globally, it is estimated that 510.6% of individuals with chronic HBV are coinfected with HDV, representing up to 72 million people worldwide . The prevalence of HDV/HBV coinfection varies geographically. HDV coinfection is highly endemic in the Mediterranean basin, Vietnam, Pakistan, Iran, Mongolia, Romania, Central Africa, West Africa, and the Amazon Basin, with estimates of prevalence exceeding 20% in these regions . The prevalence of HDV coinfection has been reported to be as high as 42% in the Brazilian Amazon , and 75% among HIV-infected injection drug users in Taiwan . In the US, HDV/HBV coinfection is associated with higher healthcare utilization and costs than HBV monoinfection .
As a result of HBV vaccination, the prevalence of HDV infection has declined since the 1990s in certain parts of Europe, particularly Italy , Spain , and Turkey , where the prevalence has stabilized around 811% . However, a resurgence of HDV infection has been observed in some countries due to increases in injection drug use, unprotected sex, and immigration of persons from highly endemic regions .
Questions For A Doctor Or Healthcare Professional
A doctor or healthcare professional can give you guidelines on how to best manage your chronic hep B. Together, you can develop a plan that minimizes your chances of complications.
Some questions you may want to ask a doctor include:
- Do I have acute or chronic hep B?
- What do the results of my blood test mean?
- Should I be taking medication?
- What should I do to monitor my disease?
- Are there any clinical trials that Im eligible for?
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Adults Living With Hepatitis B
If you test positive for the hepatitis B virus for longer than 6 months, this indicates that you have a chronic hepatitis B infection.
All patients with chronic hepatitis B infections, including children and adults, should be monitored regularly since they are at increased risk for developing cirrhosis, liver failure, or liver cancer.
You should make an appointment with a hepatologist or gastroenterologist familiar with hepatitis B. This specialist will order blood tests and possibly a liver ultrasound to evaluate your hepatitis B status and the health of your liver. Your doctor will probably want to see you at least once or twice a year to monitor your hepatitis B and determine if you would benefit from treatment.
Not everyone who tests positive for hepatitis B will require medication. Depending on your test results, you and your doctor might decide to wait and monitor your condition. If your test results indicate that you would be a good candidate for treatment, then your doctor will discuss the current treatment options with you. Whether you start treatment or not, your doctor will want to see you every six months, or at minimum once every year.
Before you start any treatment, make sure you research each treatment option, and ask your doctor to thoroughly explain each option, so that you are well informed. It also might be a good idea to get a second opinion from another doctor before starting any treatment, because more information is always better!