Should all patients with chronic hepatitis B be on treatment?

Not all patients with chronic hepatitis B (HBV) need to be on treatment. 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.

Will treatment of hepatitis B cure the infection?

There is no cure for HBV at this time, but treatment can stop the virus from replicating and triggering liver damage. HBV treatments lower the risk of developing cirrhosis and liver cancer.

What treatments are available for chronic hepatitis B?

Treatment is an oral antiviral medication. In rare cases, injections may be used.

Oral antiviral medications

There are five oral medications approved by the FDA.

• Entecavir
• Tenofovir disoproxil fumarate (TDF)
• Tenofovir alafenamide (TAF)
• Lamivudine
• Adefovir

Of these, tenofovir and entecavir are most commonly used. Uncommon adverse effects can include nausea, abdominal pain, diarrhea, headache, fatigue, and dizziness. Talk with your provider if you experience any of these adverse effects.

Medications for hepatitis B are:

• Easy to tolerate without many side effects
• Taken by mouth once per day
• Usually taken indefinitely

Patients who have both chronic HBV and HIV are typically on an HIV medication that includes drugs that treat HBV. If your HIV medication does not contain at least two drugs that work against HBV, your provider may prescribe an additional medication.

Injections: Interferon and pegylated interferon

Pegylated interferon is given as an injection once per week. It can be used alone or with an oral hepatitis B medication. Patients with both chronic hepatitis B and hepatitis D infection may need pegylated interferon alone or combined with an oral hepatitis B pill.

• Pegylated interferon therapy is usually given for 48 weeks.
• Pegylated interferon may cause many side effects, such as flu-like symptoms, rashes, irritability, and depression.
• Side effects to interferon require close monitoring with routine blood tests.

What will I need to do if I am on hepatitis B medications?

• Take oral medications every day to avoid developing resistance.
• See your provider on a regular basis
• If you have cirrhosis or high risk of liver cancer, get liver imaging on time as prescribed by your provider
• Have periodic laboratory tests to monitor HBV viral load and liver enzymes to monitor disease activity and response to medications
  • You may need blood tests every 3-6 months initially and at least once a year thereafter if virus is undetected in blood.

Besides taking medication, what else can I do to stay healthy if I have hepatitis B?

If you have chronic hepatitis B, here are some suggestions on how to keep yourself healthy:

• Avoid alcohol completely.
• Do not smoke.
• Maintain a healthy weight.
• Avoid unsafe sex.
• Avoid sharing needles. If you use injection drugs, ask your provider about getting sterile syringes.
• See your provider routinely to monitor your liver health.
• Get vaccinated if not immune to Hepatitis A.
• Stay up to date on vaccinations for influenza, pneumonia, tetanus/diphtheria/pertussis, shingles, and COVID-19.
• Learn how to protect yourself from other hepatitis viruses.
• If you or your parents were born outside the USA, ask your provider if other family members should be tested for HBV (HBV is very common is some countries).