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.
How Long Does It Take To Recover
The recovery period depends on how much the virus has affected your liver and how far your body has cooperated with the antiviral drugs. For some, the results of the treatment can be immediate, but for others, it can be long term. The antiviral drugs may also not work across for some sections of people. Consult with your doctor about these implications and the recovery period.
Are There Any Side Effects
Yes, these antiviral drugs and medications are of strong dosages, and there can be side effects that can be short term to long term. Consult with your doctor about your medical conditions and take care of the symptoms that can arise as a result of using these medications. There can be some interferon shots given to young people who do not want long-term treatments, and those side effects can include depression and difficulty in breathing.
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Do Medicines Used To Treat Autoimmune Hepatitis Have Side Effects
Medicines for autoimmune hepatitis can cause side effects. Your doctor will monitor any side effects and help you manage them while you take these medicines. Your doctor also may adjust the doses or change the medicines you take. You may need to stop taking corticosteroids or azathioprine if you have severe side effects.
Side effects of corticosteroids may include
- changes in how you look, which may include weight gain, a fuller face, acne, or more facial hair
Corticosteroids and azathioprine suppress, or decrease the activity of, your immune system, which increases your risk for infections. These medicines can also increase your risk of developing cancers, especially skin cancers.
New Hepatitis B Drug Development Disillusions: Time To Reset
- Jean-Michel PawlotskyCorrespondence ContactAffiliationsNational Reference Center for Viral Hepatitis B, C, and D, Department of Virology, Hôpital Henri Mondor, Université Paris-Est, Créteil, FranceInserm U955, Créteil, France
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What Are The Risks For Hepatitis B
Adults with a normal immune system who acquire hepatitis B have approximately a 95% chance of eventually eliminating the virus and making a complete recovery. During the weeks that the body is fighting the virus, the person may be very sick and a few may even die. Patients who do not clear the virus are chronically infected. The U.S. Centers for Disease Control and Prevention estimates that more than one million Americans are chronically infected with HBV.
As discussed above, chronic infection with hepatitis B can cause cirrhosis, liver failure, or even death. Patients with chronic hepatitis B infection are also at risk for liver cancer . Between 15% and 25% of people with chronic infection will die prematurely from complications of hepatitis B. In the United States, chronic HBV infection was listed as the cause of 1,873 deaths in 2013.
Prevention is vital to avoid hepatitis B virus infection. The current recommendation is that all children be vaccinated. Additionally, the following individuals should receive the hepatitis B vaccine:
- adults at high risk ,
- household contacts of infected persons,
- individuals on hemodialysis,
- intravenous drug users, and
- persons with multiple sexual partners.
If a person is exposed to hepatitis B, then hepatitis B immune globulin is sometimes recommended. Hepatitis B immune globulin contains antibodies to the virus which can help reduce the risk of disease.
How do nucleoside/nucleotide analogues work?
Dosing of nucleoside/nucleotide analogues
Hepatitis B Treatment: Medication
There are five FDA-approved oral medications and one injection available to treat hepatitis B. The newer oral medications are stronger and less likely to develop viral resistance and have very few side effects.
The medication cannot cure the disease, but can help reduce the number of viruses in the body and the risk of complications. You may undergo periodic blood tests to monitor drug resistance and determine whether the medication is having an effect.
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Interferons For Hepatitis B
How interferons work
Interferons are naturally occurring proteins in the body that help the body’s natural defense system fight viruses. Interferon alfa-2b and pegylated interferon alfa-2a are proteins specifically designed to attach to the surface of the hepatitis B virus. Once attached, the proteins start a cascade of events leading to increased viral cell death. Pegylated interferon works in the same way as interferon alfa-2b, but it has an added structure that enables it to stay in the body longer and does not need to be administered as often. For this reason, and because studies have shown increased effectiveness, pegylated interferon is usually the agent of choice when an interferon product is used.
Who should not use interferons?
- Individuals who have experienced an allergic reaction to interferons should not take this medication.
- A “black box” warning has been issued by the FDA warning patients and clinicians to watch for serious psychiatric, autoimmune, ischemic, or infectious disease disorders that may be side effects of interferons. Caution is especially urged if patients already have a history of depression or another serious psychiatric condition.
- Pegylated interferon is not used in newborn infants , in patients with autoimmune hepatitis, or in those with severe liver failure .
- The safety and efficacy of pegylated interferon has not been established in patients under the age of 18.
Dosing of interferons
Drug or food interactions of interferons
Understanding Your Test Results
Understanding your hepatitis B blood tests can be confusing. It is important to talk to your health care provider so you understand your test results and your hepatitis B status. Are you infected? Protected? Or at risk? The Hepatitis B Panel of blood tests includes 3 tests and all three results must be known in order to confirm your status.
Below is a chart with the most common explanation of the test results, but unusual test results can occur. Please note that this chart is not intended as medical advice, so be sure to talk to your health care provider for a full explanation and obtain a printed copy of your test results. In some cases, a person could be referred to a liver specialist for further evaluation.
More Detailed Information About Hepatitis B Blood Tests
An acute hepatitis B infection follows a relatively long incubation period – from 60 to 150 days with an average of 90 days. It can take up to six months, however, for a person to get rid of the hepatitis B virus. And it can take up to six months for a hepatitis B blood test to show whether as person has recovered from an acute infection or has become chronically infected .
The following graphic from the U.S. Centers for Disease Control and Prevention represents the typical course of an acute hepatitis B infection from first exposure to recovery.
According to the CDC, a hepatitis B blood test result varies depending on whether the infection is a new acute infection or a chronic infection.
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How Do Doctors Treat Autoimmune Hepatitis
Doctors treat autoimmune hepatitis with medicines that suppress, or decrease the activity of, your immune system, reducing your immune systems attack on your liver. The medicines doctors most often prescribe are corticosteroidsprednisone or prednisolonewith or without another medicine called azathioprine.
Doctors typically start with a relatively high dose of corticosteroids and then gradually lower the dose. Your doctor will try to find the lowest dose that works for you. Your doctor will use blood tests to find out how you are responding to the treatment. A decrease in levels of the liver enzymes alanine transaminase and aspartate transaminase shows a response to treatment. ALT and AST falling to normal levels shows a full response. In some cases, a doctor may repeat a liver biopsy to confirm the response to treatment and find out whether the damage has resolved.
Treatment can relieve symptoms and prevent or reverse liver damage in many people with autoimmune hepatitis. Early treatment of autoimmune hepatitis can lower the chances of developing cirrhosis and other complications. A minority of people who have no symptoms or only a mild form of the disease may or may not need medicines.
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.
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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.
What Causes Hepatitis B
HBV is a tiny organism found in high concentrations in the liver and blood of infected individuals. It is transmitted through contact with infected blood or contact with secretions contaminated with blood cells. For example:
- intravenous drug users acquire the infection through sharing dirty needles
- health care workers can acquire hepatitis B through accidental needle sticks from infected patients
- one of the major routes of infection is from an infected mother to her newborn child. Although these infants may not get very sick, they are very likely to become chronic carriers of the virus and to suffer complications of the infection in later life. Fortunately, prompt vaccination of newborns and other measures can provide significant protection for infants at risk.
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How Is The Treatment Done
The hepatitis B treatment depends on how far the virus has spread in your body and how much damage your liver has undergone. The treatment also depends majorly on how free your body is from other chronic medical ailments. The best treatment that can ultimately curb the virus from becoming active in your body is to take the hepatitis B vaccine. Also, you really have to be careful, and you should avoid from getting an unprotected sex. Also there more chances of you getting the infection from sharing the needles with your drug partner. The virus strain can be either acute or chronic. For the acute cases, you might not need any medications. You have to change your dietary patterns, and you have intake a lot of fluids. However, you have to go for regular visits to your doctor to check for the activeness of the virus. In chronic cases, you may have to depend on medications, and these can be for an extended period. The medications act differently for every individual, and there is no specific time limit for getting cured. In advanced cases when your liver is beyond repair, a liver transplant might be the only solution, and even that cannot be possible for many individuals.
How Do Doctors Treat The Complications Of Autoimmune Hepatitis
If autoimmune hepatitis leads to cirrhosis, doctors can treat health problems and complications related to cirrhosis with medicines, surgery, and other medical procedures. If you have cirrhosis, you have a greater chance of developing liver cancer. Your doctor may order an ultrasound or other types of imaging tests to check for liver cancer.
If autoimmune hepatitis causes acute liver failure or cirrhosis with liver cancer or liver failure, you may need a liver transplant.
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What Is Hepatitis C
Hepatitis C is a viral infection that causes liver inflammation and damage. Inflammation is swelling that occurs when tissues of the body become injured or infected. Inflammation can damage organs.
Viruses invade normal cells in your body. Many viruses cause infections that can be spread from person to person. The hepatitis C virus spreads through contact with an infected persons blood.
Hepatitis C can cause an acute or chronic infection.
Although no vaccine for hepatitis C is available, you can take steps to protect yourself from hepatitis C. If you have hepatitis C, talk with your doctor about treatment. Medicines can cure most cases of hepatitis C.
Causes And Risk Factors
Hepatitis B is caused by a viral infection. The virus can survive outside of the body for at least seven days. During this time, it can infect a person if it enters his or her body. It can be detected within 30 to 60 days after infection. It can persist and develop into chronic hepatitis B, especially if someone is infected at a young age.
It can be transmitted or spread in several ways, including :
Anyone can get this virus. But some people are at a greater risk of exposure to the virus. This includes people who:
- Have multiple sexual partners
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Clinical Relevance And Detection Of Drug Resistance
The clinical relevance of drug resistance became dramatically clear after the introduction of the first nucleoside analogue LMV that has a low barrier to resistance. LMV-resistant mutations arise in about 23% of patients after 12 months of therapy and in up to 80% after 5 years of treatment . Patients with LMV-resistant mutations have a higher risk of deteriorating liver function , increasing signs of liver injury as well as developing cirrhosis and hepatocellular carcinoma, all in comparison to patients with wildtype virus under antiviral therapy . Viral rebound and hepatic decompensation is also observed with other drug-resistant HBV mutants . The risk of selecting antiviral therapy-resistant mutants is related to the pretreatment HBV DNA level, the choice of the antiviral , the duration of treatment, the rapidity of viral response/viral suppression as well as to the previous exposure to nucleotide/nucleoside analogues . In order to reduce the risk of drug resistance, all guidelines now recommend the use of newer, highly potent antivirals with a high barrier to resistance such as ETV or TDF .
Figure 1
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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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