Origin Of Antiviral Resistance
The genetic makeup of viruses is constantly changing, which can cause a virus to become resistant to currently available treatments. Viruses can become resistant through spontaneous or intermittent mechanisms throughout the course of an antiviral treatment. Immunocompromised patients, more often than immunocompetent patients, hospitalized with are at the highest risk of developing oseltamivir resistance during treatment. Subsequent to exposure to someone else with the flu, those who received oseltamivir for “post-exposure prophylaxis” are also at higher risk of resistance.
Multiple strains of one virus can be present in the body at one time, and some of these strains may contain mutations that cause antiviral resistance. This effect, called the , results in immense variation in any given sample of virus, and gives the opportunity for natural selection to favor viral strains with the highest fitness every time the virus is spread to a new host. Also, recombination, the joining of two different viral variants, and , the swapping of viral gene segments among viruses in the same cell, play a role in resistance, especially in influenza.
Antiviral resistance has been reported in antivirals for herpes, HIV, hepatitis B and C, and influenza, but antiviral resistance is a possibility for all viruses. Mechanisms of antiviral resistance vary between virus types.
Hepatitis B And Your Liver
The liver is such an important organ that we can survive only one or two days if it completely shuts down – if the liver fails, your body will fail, too. Fortunately, the liver can function even when up to 80% of it is diseased or removed. This is because it has the amazing ability to regenerate – or create – itself from healthy liver cells that still exist.
If your body were an automobile, your liver would be considered the engine. It does hundreds of vital things to make sure everything runs smoothly:
- Stores vitamins, sugar and iron to help give your body energy
- Controls the production and removal of cholesterol
- Clears your blood of waste products, drugs and other poisonous substances
- Makes clotting factors to stop excessive bleeding after cuts or injuries
- Produces immune factors and removes bacteria from the bloodstream to combat infection
- Releases a substance called “bile” to help digest food and absorb important nutrients
The word hepatitis actually means inflammation of the liver. Thus, hepatitis B refers to inflammation of the liver caused by the hepatitis B virus. With early detection and appropriate follow-up medical care, people living with a chronic hepatitis B infection can expect to enjoy a long and healthy life.
How Can I Pay For My Medication
Private health insurance or drug plansIf you have private health insurance or a drug plan at work, you may be able to have the medication paid through your plan. Please consult your private health insurance or drug plan provider to see if your drug is covered.
Publicly funded drug plansEach province and territory has their own rules. Some provincial drug plans provide coverage for individuals 65 and older, or those on social assistance. Some provinces provide special support to low-income individuals. Please call your Provincial Ministry or Department of Health to get more information about the terms of the publicly funded drug plan in your province.
Quebec public drug programIn Quebec, everyone must be covered by prescription drug insurance either through private or publicly funded plans.
Each provincial and territorial government offers a drug benefit plan for eligible groups. Some are income-based universal programs. Most have specific programs for population groups that may require more enhanced coverage for high drug costs. These groups include seniors, recipients of social assistance, and individuals with diseases or conditions that are associated with high drug costs. For more details, please contact your provincial or territorial health care ministry, or click on the appropriate link below.
Yukon
Available Patient Assistance Program for Hepatitis B treatment VEMLIDY
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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.
If I Have No Symptoms How Would I Know If I Have Hepatitis B
To confirm whether or not you have hepatitis B, you will need blood tests.
If you have at least one risk factor , you should ask your health care provider to be tested for hepatitis B. Also, you should be tested for hepatitis B if:
- you were born in a region where hepatitis B is more common, including Asia, Africa, southern and eastern Europe, the Pacific Islands, the Middle East, and the Arctic
- one or both of your parents immigrated from a region where hepatitis B is more common
- you live or travel to regions where hepatitis B is more common
- you have a family history of liver disease or liver cancer
- you have been in prison
- you are pregnant
- you have ever used injection drugs, even just once
- you have unexplained abnormal liver enzymes or if
- you receive medicines that suppress the immune system.
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You Can Have It And Not Know It
What is hepatitis B?
Hepatitis B is a liver disease caused by the hepatitis B virus . HBV is far more infectious than HIV and can be prevented by a vaccine. People who have not been vaccinated may be at risk of getting infected.
About 95 percent of adults will recover within 6 months of becoming infected and as a result will develop lifelong protection against it. The remaining 5 percent are unable to clear the virus and will become chronically infected. Chronic hepatitis B infection is treatable.
It is estimated that less than 1 percent of Canada’s population is infected with either acute or chronic HBV. People who are infected before the age of 7 are at a higher risk of developing chronic infection. In 2011, the overall reported rate of acute hepatitis B infection in Canada was 0.6 reported cases per 100,000 people living in Canada.
Why is hepatitis B a health concern?
Many people infected with HBV do not know they have the virus because symptoms can take two to six months to appear and only about 50 percent of people develop symptoms. During this time, they can spread the infection to others. You may not know you have this infection until damage has already been done to your liver. Potential complications from chronic HBV infection include cirrhosis of the liver, liver failure, liver cancer and premature death.
Why do I need my liver?
How is hepatitis B spread?
HBV is spread through contact with infected blood and body fluids including semen and vaginal fluid.
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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Natural History Of Chronic Hbv Infection
The natural course of chronic hepatitis B infection is generally described in four phases: immune tolerant, immune clearance, low or nonreplicative , and reactivation phases . Patients may progress from one phase to the next or reverse backwards. Active viral replication is the hallmark of the immune tolerant, immune clearance, and reactivation phases. The different phases represent the interaction between the host immune system and the virus. The natural history is modified by gender, alcohol consumption, and co-infection by other viruses. In general, the outcome of HBV infection depends on the duration and severity of liver injury. The earlier HBV replication is arrested, the less is the cumulative liver injury.
Phases of Chronic HBV Infection
Replicative PhaseâImmune Tolerant Phase
The exact mechanism of immune tolerance is unclear. Studies in transgenic mice suggest that exposure to HBeAg results in a state of immune tolerance. Helper T cells become unresponsive to both HBeAg and hepatitis B core antigen because of cross-reactivity.21 Thus cytotoxic T-cell response to hepatitis B core antigen is rendered ineffective. Moreover, after stimulation by recombinant hepatitis B core antigen, peripheral blood mononuclear cells fail to proliferate and produce interleukin-2 receptors.22
Replicative PhaseâImmune Clearance Phase
Low or Nonreplicative Phase
Reactivation Phase
T. Shaw, S.A. Locarnini, in, 2004
Acute Hepatitis B Symptoms
There are three phases of acute hepatitis B infection, and symptoms may differ depending on the stage. Early in the disease, called the prodromal phase, symptoms may include:
- Fever
- Dark urine and light stool color
During the icteric phase:
- Jaundice develops
- Anorexia, nausea and vomiting may worsen
- Irritated skin lesions may develop
- Other symptoms may subside
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What Are Clinical Trials For Hepatitis B
Clinical trialsand other types of clinical studiesare part of medical research and involve people like you. When you volunteer to take part in a clinical study, you help doctors and researchers learn more about disease and improve health care for people in the future.
Researchers are studying many aspects of hepatitis B, such as
- progression of hepatitis B and long-term outcomes
- new treatments for hepatitis B
- prevention of reactivated or worsening hepatitis B in people receiving cancer treatment
Prevention Of Hepatitis B
Hepatitis B can be prevented through vaccination. The hepatitis B vaccine typically is given as a series of three or four injections, administered over the course of six months. The first dose of the vaccine is sometimes called the birth dose, since it frequently is given within the first 24 hours of birth. The vaccine is 90 to 95 percent effective in preventing hepatitis B.
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Complications Of Hepatitis B
A small proportion of people who become infected with the hepatitis B virus develop a long-term hepatitis B infection. They may have the virus in their bloodstream for most of their life without realising they are infected.
People with chronic hepatitis B infection may not notice any health problems until they develop liver problems such as liver disease or liver cancer later in life. Treatment for hepatitis B is essential because it is not possible to be a healthy carrier of the hepatitis B virus. Chronic hepatitis B infection occurs more commonly in some communities, including:
- Aboriginal and Torres Strait Islander communities.
- In people from parts of the world where hepatitis B is more common, such as:
- North-East Asia
- Sub-Saharan Africa.
How Is It Transmitted
Hepatitis B is highly infectious, and is spread from one person to another through exposure to infected blood and body fluids . It can be spread through:
- blood transfusions or organ transplantation in countries where blood or blood products have not been properly screened for hepatitis B and other viruses transmitted through blood
- unprotected sex with an infected person
- sharing needles or equipment for injecting drugs
- unsterilized medical/dental equipment and shared/contaminated materials or equipment used for tattooing, body piercing or acupuncture
- sharing toothbrushes or razors
- childbirth
- household contact between family members
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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
Examples Of Hepatitis In A Sentence
hepatitis CNNhepatitis ChronhepatitisArkansas OnlinehepatitisBostonGlobe.comhepatitisAnchorage Daily NewshepatitisWSJhepatitisThe Courier-JournalhepatitisForbes
These example sentences are selected automatically from various online news sources to reflect current usage of the word ‘hepatitis.’ Views expressed in the examples do not represent the opinion of Merriam-Webster or its editors. Send us feedback.
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Should I Be Screened For Hepatitis B
Screening is testing for a disease in people who have no symptoms. Doctors use blood tests to screen for hepatitis B. Many people who have hepatitis B dont have symptoms and dont know they are infected with hepatitis B. Screening tests can help doctors diagnose and treat hepatitis B, which can lower your chances of developing serious health problems.
Your doctor may recommend screening for hepatitis B if you9,14
- are pregnant
- were born in an area of the world where 2 percent or more of the population has hepatitis B infection, which includes Africa, Asia, and parts of the Middle East, Eastern Europe, and South America
- didnt receive the hepatitis B vaccine as an infant and have parents who were born in an area where 8 percent or more of the population had hepatitis B infection, which includes sub-Saharan Africa and parts of Asia
- are HIV-positive
- are a man who has sex with men
- have lived with or had sex with a person who has hepatitis B
- have an increased chance of infection due to other factors
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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Prevent Hepatitis B Infections In Newborns
If you are pregnant and have hepatitis B, talk with your doctor about lowering the risk that the infection will spread to your baby. Your doctor will check your virus levels during pregnancy. If virus levels are high, your doctor may recommend treatment during pregnancy to lower virus levels and reduce the chance that hepatitis B will spread to your baby. Your doctor may refer you to a liver specialist to find out if you need hepatitis B treatment and to check for liver damage.
When it is time to give birth, tell the doctor and staff who deliver your baby that you have hepatitis B. A health care professional should give your baby the hepatitis B vaccine and HBIG right after birth. The vaccine and HBIG will greatly reduce the chance of your baby getting the infection.
Treatment Options For Hepatitis B
Acute hepatitis B usually doesnt require treatment. Most people will overcome an acute infection on their own. However, rest and hydration will help you recover.
Antiviral medications are used to treat chronic hepatitis B. These help you fight the virus. They may also reduce the risk of future liver complications.
You may need a liver transplant if hepatitis B has severely damaged your liver. A liver transplant means a surgeon will remove your liver and replace it with a donor liver. Most donor livers come from deceased donors.
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What Problems Can Hepatitis B Cause
Hepatitis B is a serious infection. It can lead to cirrhosis of the liver, liver failure, or liver cancer, which can cause severe illness and even death.
If a pregnant woman has the hepatitis B virus, her baby has a very high chance of having it unless the baby gets a special immune injection and the first dose of hepatitis B vaccine at birth.
Sometimes, HBV doesn’t cause symptoms until a person has had the infection for a while. At that stage, the person already might have more serious problems, such as liver damage.
What Is Chronic Hepatitis B
Doctors refer to hepatitis B infections as either acute or chronic:
- An acute HBV infection is a short-term illness that clears within 6 months of when a person is exposed to the virus.
- A person who still has HBV after 6 months is said to have a chronic hepatitis B infection. This is a long-term illness, meaning the virus stays in the body and causes lifelong illness. An estimated 850,000 to more than 2 million people in the U.S. have chronic HBV.
The younger someone is when infected, the greater the chances for chronic hepatitis B.
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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.