The decision to treat HBV is based on several factors including blood tests results, the patient's age, and the risk of developing cirrhosis or liver cancer. Sometimes a liver biopsy is needed to see if there is significant liver damage or scarring to make a decision. Hepatitis B medications are recommended for patients with detected HBV virus also known as hepatitis B viral load on a blood test and evidence of liver damage.
Liver damage can be detected with a liver enzyme known as ALT. People with cirrhosis should be considered for treatment even if the liver enzymes appear normal. Chronic hepatitis B may change over time. Patients can go through different phases with low amounts of virus and normal level of ALT followed by high viral loads and ALT levels. These bursts of virus activity usually don't cause any symptoms but may cause liver damage overtime. It is important that people with chronic hepatitis B have blood tests on a regular basis to see if treatment is needed.
There are some medications which can cause hepatitis B "reactivation" which can lead to life threatening liver failure. These medications are used to treat some cancers, inflammatory conditions and hepatitis C. Reactivation reactions can be prevented and it is important to let your provider know you have HBV before you start any new medications. There is no cure for HBV at this time, but treatment can stop the virus from replicating and triggering liver damage.
Some patients ultimately lose HBsAg and this final phase is referred to as resolution of infection. Natural history of HBV infection. Adults who are infected with HBV usually develop an acute hepatitis that resolves spontaneously. HBV transmission can be prevented by screening of donated blood, plasma, organ tissue and semen, by virus inactivation in plasma-derived products, by risk-reduction counselling and by implementation of infection control practices.
However, the single most effective prevention measure is routine immunization for infants. Babies born to HBsAg carrier mothers should be protected against perinatal transmission by administration of hepatitis B immunoglobulin and HBV vaccine. The diagnosis of chronic HBV infection is made from its biochemical, virological and histological features together with exclusion of other causes such as HCV. HBV DNA can be monitored in serum by means of DNA hybridization with signal amplification, to assess disease activity and candidacy for antiviral therapy and to determine response to treatment.
Liver biopsy is essential to confirm the diagnosis, to identify any intercurrent disease affecting the liver, to stage the fibrosis and to grade the necroinflammation. Box 1 HBV markers and their properties. HBeAg: viral product secreted in blood, marker of infectivity, active replication though absent in precore mutants.
The main goal of treatment of chronic hepatitis B is to suppress HBV replication and to induce remission of liver disease before development of cirrhosis and hepatocellular carcinoma. The advantages of interferon include finite duration of treatment, lack of resistant mutants and durable response; disadvantages are high cost, the need for subcutaneous administration and the side-effects.
Treatment is not recommended for patients with mild chronic hepatitis B because of the low efficacy of existing therapies, but these patients should be monitored. The American Association for the Study of Liver Disease 7 recommends that patients who are HBeAg-positive with moderate or severe chronic hepatitis and raised aminotransferases more than twice the upper limit of normal should be offered either: i a month course of interferon 10 MU thrice weekly ; or ii a 1-year course of lamivudine mg once a day if no HIV infection ; or iii a 1-year course of adefovir 10 mg once a day.
Since the viral response to lamivudine or adefovir is not affected by previous failure with interferon, the European Association for Study of the Liver favours using interferon first.
An alternative is to switch to adefovir. Patients with compensated cirrhosis and raised HBV DNA levels can be treated with lamivudine or adefovir but interferon can cause flares and should be avoided. American Association for the Study of Liver Disease recommendations for the treatment of chronic hepatitis B modified from Ref.
The ideal approach to antiviral therapy in chronic hepatitis B remains uncertain. In most patients monotherapy is insufficient to eradicate infection.
Peginterferon alpha-2a is currently under evaluation and data from the phase II trials suggest a greater than twofold higher combined response rate HBeAg loss, HBV DNA suppression and normalization of alanine aminotransferase than with conventional interferon after 24 weeks. Note Professor Foster acts as a consultant to companies that market drugs for treatment of hepatitis B. This content does not have an English version. This content does not have an Arabic version.
Diagnosis Your doctor will examine you and look for signs of liver damage, such as yellowing skin or belly pain. Tests that can help diagnose hepatitis B or its complications are: Blood tests. Blood tests can detect signs of the hepatitis B virus in your body and tell your doctor whether it's acute or chronic.
A simple blood test can also determine if you're immune to the condition. Liver ultrasound. A special ultrasound called transient elastography can show the amount of liver damage. Liver biopsy. Your doctor might remove a small sample of your liver for testing liver biopsy to check for liver damage. During this test, your doctor inserts a thin needle through your skin and into your liver and removes a tissue sample for laboratory analysis.
More Information Liver biopsy Liver function tests. Email address. First Name let us know your preferred name. Last Name. Thank you for subscribing Your in-depth digestive health guide will be in your inbox shortly.
Sorry something went wrong with your subscription Please, try again in a couple of minutes Retry. More Information Liver transplant. Request an Appointment at Mayo Clinic. Share on: Facebook Twitter. Show references Lok AS. Hepatitis B virus: Clinical manifestations and natural history. Accessed Aug. Lok AS. Hepatitis B virus: Screening and diagnosis.
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