Social

Treatment
Change in lifestyle
An acute infection of Hepatitis B often does not require treatment and
about 2/3 of the time it even goes by unnoticed. The general advice is to
take a rest and a good intake of fluids and food is the common advice and
usually the disease resolves itself. 1/3th of the patient may feel feverish,
anorexia, nausea or body aches and may show some symptoms of
hepatitis but also generally wont need any treatment. In about 1% of
people a very aggressive form named fulminant hepatitis comes up, which
is a dangerous form of liver failure, which sometimes needs a liver
transplant
The complications of damage from Chronic hepatitis B can be much more
severe.
Hepatitis B and related diseases like cirrhosis, liver failure or
hepatocellular carcinomas result in the death of between 500.000 to one
million people annually. Taking in mind that 350-400 million people have
Chronic Hepatitis B, it ca be said that most people with chronic hepatitis B
do not develop these complications and live long and healthy lives.
What is interesting about hepatitis is that the course of the disease
Hepatitis B is very variable. It can for example lead to the
abovementioned complications in a relatively short period of time. But It is
for example possible that someone that is infected is in a stage of the
disease, for example an inactive carrier stage, in which there is a very low
risk of developing extra liver damage like cirrhosis or cancers for multiple
decades. In these cases, there is no treatment needed. What is needed
are regular follow-ups, about every 6 months, to monitor the
beforementioned biomarkers to see if there are any changes in the
stability of the disease. If the biomarker ALT is found to be above a certain
normal baseline, indications of fibrosis, necroinflammation or the patient
for example has active liver disease, then treatment might be needed.
Age and family health status are also important for the assessment.
It is important to note that in most people, the treatment does not cure
hepatitis B infection due to the persistence of covalently closed circular
DNA (cccDNA) in the nucleus of infected hepatocytes. Therefore the goal
of the treatment is to suppress the Hepatitis B viral replication. The
accompanying reduction in histological activity of chronic hepatitis B
reduces the risk of cirrhosis, liver failure and hepatocellular carcinoma, a
specific type of liver cancer. This means that sometimes the drugs have to
be taken for life.
Two types of treatment:
Nucleotide/Nucleoside Analogues. These work by being Antiviral Drugs,
which stop the cells from replication: these oral drugs work by slowing

down or stopping the reproduction of the virus in the liver cell. (daily).
They do no
-Epivir-HBV first line
-Hepsera first line
-Baraclude second line Entecafir
-Tyzeka second line
-Viread second line Tenofovir
Immune Modulator Drugs, also known as interferons: these injectables
work by boosting the immune response of the patients. Cytokines to
trigger immune response.
-Intron A
-Pegasys Interferon
The advantage of the pegasys interferon is that there is an absence of
resistance and the potential for immune mediated control of the infection.
Frequent side effects are a problem though.

Currently, there are two different treatment strategies for both

HBeAg-positive and HBeAg-negative CHB patients: treatment of
finite duration with (PEG-)IFN or a NA and long-term treatment with
NA(s).
The main theoretical advantages of (PEG-)IFN are the absence of
resistance and the potential for immune-mediated control of HBV
infection with an opportunity to obtain a sustained virological
response off-treatment and a chance of HBsAg loss in patients
who achieve and maintain undetectable HBV DNA. Frequent side
effects and subcutaneous injection are the main disadvantages of
(PEG-)IFN treatment. (PEG-)IFN is contraindicated in patients with
decompensated HBV-related cirrhosis or autoimmune disease, in
patients with uncontrolled severe depression or psychosis, and in
female patients during pregnancy ( A1).
Entecavir and tenofovir are potent HBV inhibitors with a high
barrier to resistance [[67], [70], [78], [85], [92], [123]] (Fig. 1). Thus,

they can be confidently used as first-line monotherapies [1] ( A1)

Generally more expensive

There is still limited access to diagnosis and treatment of hepatitis B in many

resource-constrained settings, and many people are diagnosed only when
they already have advanced liver disease. Liver cancer progresses rapidly,
and since treatment options are limited, the outcome is in general poor. In lowincome settings, most people with liver cancer die within months of diagnosis.
In high-income countries, surgery and chemotherapy can prolong life for up to
a few years. Liver transplantation is sometimes used in people with cirrhosis in
high income countries, with varying success

but studies in China have shown that even insured

patients spend more than 40% of their disposable
household income on treatment of Hepatitis B related
disease.
(http://onlinelibrary.wiley.com/store/10.1111/j.15244733.2009.00636.x/asset/j.15244733.2009.00636.x.pdf;jsessionid=539E0F12DCEAABD
2EAA0EC52F2A42B99.f02t03?
v=1&t=it1olpjr&s=5ae7c341f7b11cac1886d2900abe7c
6ca482ed67). And in the United States where there are
1.25 million people with Chronic Hepatitis B, the
economic burden is almost 1 billion dollars yearly.