For more information please read the following article from The New York Times: Weighing the Options for Hepatitis B
What is viral hepatitis and why does it need to be treated?
- Viral hepatitis is usually caused by the hepatitis A, B, and C viruses.
- Both hepatitis B and hepatitis C infection can persist in the body and become longstanding infections (chronic).
- These types of viral hepatitis can be readily distinguished by simple blood tests.
- The two most common forms of chronic hepatitis are caused by hepatitis B and C.
- Many people with chronic hepatitis B and C can lead normal lives without developing problems from liver disease.
- But chronic hepatitis B and hepatitis C can also lead to cirrhosis, liver failure, liver cancer, and even death.
- Because patients with chronic hepatitis B and hepatitis C may not feel sick until they develop severe liver problems, they should be identified as soon as possible (see Viral Hepatitis Screening) and treatment should be considered.
- Because hepatitis B and C are different viruses, they require different approaches to treatment.
- Acute hepatitis infection is most commonly caused by hepatitis A and hepatitis B and is not usually treated with specific hepatitis medications.
Treatment of Hepatitis B
Is chronic hepatitis B treatable?
- Current treatments for hepatitis B are very effective at controlling or suppressing the hepatitis B virus. However, hepatitis B treatment only rarely leads to “cure”.
What treatments are available?
Should everyone with hepatitis B be treated?
- Not everyone with hepatitis B needs treatment. Those with inactive hepatitis B {who test positive for hepatitis B surface antigen (HBsAg) but who don’t have liver damage} generally do not require treatment.
- Hepatitis B treatment should only be considered in those with active liver disease.
- Persons with active liver disease usually have increased liver enzymes, hepatitis B virus detected in blood, and damage shown on liver biopsy if performed.
What are the goals of hepatitis B treatment?
- Prevention of serious and even life-threatening consequences of long-standing infection.
- Lowering of hepatitis B virus levels over a long period that can be measured by blood tests for hepatitis B viral DNA (HBV DNA) and hepatitis B e antigen (HBeAg). These tests measure how the virus multiplies or grows.
- Loss of HBeAg in those who were initially positive, since treatment can generally be safely stopped in these individuals.
- Improving liver tests that will often become normal or close to normal if treatment is successful.
- Loss of hepatitis B surface antigen (HBsAg). This comes closest to a “cure” of the infection but does not occur very often.
What are the chances of responding to hepatitis B treatment?
- Almost all patients can achieve an initial lowering of their blood levels of HBV DNA and liver enzymes.
- Treatment with oral therapy can keep viral levels low and liver enzymes normal over prolonged periods, as long as the virus doesn’t develop resistance to therapy.
- Treatment with interferon/peginterferon can lead to loss of HBeAg in about a third of patients.
- Treatment with oral therapy can lead to loss of HBeAg in about one fifth of patients after one year. Responses will increase further over time.
- Only a small portion of treated patients clear HBsAg.
How long must hepatitis B treatment be taken?
- Interferon/peginterferon is given for 6 to 12 months.
- Oral drugs may need to be given beyond one year depending on the response.
- Patients who are negative for HBeAg before therapy often require prolonged and even indefinite treatment to keep the infection under control.
What are the risks of hepatitis B treatment?
- Oral hepatitis B drugs are very well tolerated with few side effects. The main concern with their use is the risk that the hepatitis B virus may become resistant and may no longer respond to treatment. Resistance may then lead to a change in therapy including the use of other drugs given alone or in combination.
- Pegylated interferon is associated with side effects that include fatigue, body aches, and mood changes such as depression.
- Since some hepatitis B medications are new, there may be risks that have not yet been identified.
Hepatitis C
Is chronic hepatitis C treatable?
- Hepatitis C is very much a treatable condition.
What treatments are available?
Treatment is with interferon (shots) and ribavirin (capsules). There are three interferons approved by the Food and Drug Administration (FDA) that are currently used.
These are:
- Pegylated interferon alfa-2b (PEG INTRON)
- Pegylated interferon alfa-2a (PEGASYS)
- Consensus interferon (INFERGEN)
The two pegylated interferons are similar in their response. Less is known about consensus interferon
Should everyone with hepatitis C be treated?
- Not everyone with hepatitis C needs treatment.
- Yet everyone with hepatitis C and hepatitis C viral RNA (HCV RNA) in their blood should be considered for treatment.
- Patients with active liver disease or with scarring to the liver should be treated as long as they do not have other medical conditions that prevent them from being treated successfully.
- Those with mild hepatitis C may not need treatment because they may never develop life-threatening problems.
- Some patients have contraindications to interferon treatment such as severe depression or other medical problems and they should not be started on interferon until these medical problems are improved.
What are the goals of hepatitis C treatment?