Hepatitis - Treatments

How is it treated?

Hepatitis B that lasts beyond 6 months or becomes serious may be treated with several different medications, but not every case needs to be treated. Whether or not an individual with hepatitis B is taking medication, regular visits to a doctor who specializes in liver diseases are very important. Laboratory tests that measure liver function, need to be performed regularly to track disease progression and to determine possible complications. Because no cure has been found for hepatitis B, treatment is aimed at decreasing the ability of the virus to multiply, decreasing inflammation and damage to the liver, and increasing the immune system’s ability to fight the virus.

Currently, drug treatments seem to be most helpful for individuals who have liver disease caused by hepatitis B. Unfortunately, there is no drug treatment for the acute phase of hepatitis B. Nausea and vomiting often seen with early infection is treated with fluid replacement. In the United States, the four drugs that have been approved by the Food and Drug Administration (FDA) for treating chronic hepatitis B are:

Interferon-alpha (Intron A and Pegasys) A synthetic version of antiviral proteins produced by the immune system, artificial interferon is used to treat a number of conditions. Although it may cause side effects such as depression, headache and flu-like symptoms, interferon is approved for both children and adults with hepatitis B. It is given by injection several times a week. There is also a modified form of interferon known as peginterferon that has been approved for the treatment of Hepatitis B and C. It has a similar but larger chemical structure than interferon-alpha that improves how the drug works and only needs to be injected once weekly.

Lamivudine (Epivir-HBV) Taken orally once a day for at least a year, lamivudine is approved for use by both children and adults with chronic hepatitis B. It has very few side effects, but long term use of lamivudine is likely to cause the hepatitis virus to become resistant to the effects of this medicine. Because of this, combination therapy and the use of other medicines to treat hepatitis B are areas of intense study.

Adefovir dipivoxil (Hepsera) Approved only for adults with chronic hepatitis B, adefovir is taken once a day as an oral tablet. Studies have shown that use of adefovir has been beneficial in reducing the amount of virus in the body without causing as much resistance as lamivudine. The most common side effects experienced by patients taking this medicine are headache, throat pain, and stomach pain.

Entecavir (Baraclude) Approved by the FDA March 30,2005, entecavir resembles a product needed by viral DNA to continue growing. It has been approved for chronic hepatitis B patients in whom the virus is active and replicating. Entecavir can also be used in patients with a resistant virus who have failed lamivudine therapy. Entecavir, taken as an oral tablet or solution once daily, is tolerated as well as lamivudine. The hepatitis B virus is much less likely to develop resistance to entecavir, representing a convenient treatment option for chronically infected patients.

Therapy with one drug is still considered to be the first line treatment approach and the choice of drug is specific to each patient with chronic hepatitis B. Combination therapy with interferon alpha and a nucleoside analog (like lamivudine or entecavir) may be used to prevent viral resistance and has shown promising results in reducing viral replication. However, further studies are needed to fully evaluate the benefit of combination therapy over treatment with one drug. Your doctor may run tests to check the health of your liver if you are on medicines like adefovir, lamivudine, or entecavir. If you are on any of these medicines, tell your doctor if you experience abdominal pain, skin discoloration, orange or dark urine, and frequent diarrhea or constipation.

Prevention of hepatitis B

Hepatitis B cannot be cured, but it can be prevented relatively easily.

Before exposure to HBV

The hepatitis B vaccine (Engerix-B, Recombivax HB) is a safe and effective protection from hepatitis B. Given as three injections during a 6-month period, it generally produces immunity for 15 years or longer. Generally, the injections are given in a doctor’s office or clinic.

Currently, hepatitis B vaccination is required by many school districts before a student is admitted. It is recommended for all individuals under the age of 19 years and for individuals who:

• are homosexual men
• have kidney dialysis
• have liver diseases (including other types of hepatitis)
• have multiple sex partners
• have or ever have had a sexually transmitted disease (for example, gonorrhea or syphilis)
• have sex with a partner who has hepatitis B
• have sex with multiple partners
• live in or travel to countries where hepatitis B is common
• live in the same home as an individual who has chronic hepatitis B
• may be exposed to HVB in blood

After exposure to the virus

Individuals who know or believe that they have been exposed to HBV, including babies born to mothers who test positive for HBV, should receive the three hepatitis B vaccine injections. They should also get one injection of hepatitis B immune globulin (BayHep B, Nabi-HB). Abbreviated as HBIG, this medication is made up of immune system proteins that specifically help to fight HBV.

Drug classes used to treat Hepatitis B

Interferons

Nucleoside Reverse Transcriptase Inhibitors