Hepatitis B | All You Need to Know About Hepatitis B

Treatment And Prognosis

The treatment strategies differ for acute and chronic hepatitis B infection. An episode of acute hepatitis B infection goes away on its own and does not need any medical treatment. However, chronic hepatitis B has to be dealt with pharmacological intervention.

The following modalities are available to treat chronic hepatitis:

1) Antiviral Drugs

The first line of treatment against the activity of the virus is antiviral drugs. A wide variety of antiviral drugs available have proven to be of benefit in the fight against HBV. most commonly used drugs include:

    • Adefovir
    • Lamivudine
    • Tenofovir
    • Entecavir
    • Telbivudine

It was found in a study that the same dosage of tenofovir (300 mg) had better antiviral effects as compared to adefovir through a 48-week administration program.

A study demonstrated that lamivudine has an excellent safety profile and effectively manages patients with chronic hepatitis B.

Modern Research

Doctors and researchers are now creating better ways to deal with chronic hepatitis B patients. For example, as per a meta-analysis, it is completely safe and effective to administer prophylactic antiviral therapy to pregnant mothers to prevent mother-to-child transmission of the hepatitis B virus.

Antiviral therapy has the potential to improve symptoms and reduce viral load in patients. This therapy, paired with immune response boosts, can become more effective in the future.

Research is ongoing to discover new classes of effective and safe antiviral drugs. In addition, new direct-acting antivirals are under development that includes entry inhibitors, cccDNA targeting, and  HBsAg secretion inhibitors.

It was revealed in a 2020 study HBsAg level in the body nosedived after direct-acting antiviral therapy. So the newer class of drugs can be pretty effective for prophylaxis and management of HBV/HCV co-infected patients as well.

2) Antibody Injections

Antibodies are the body’s natural cells produced in response to a viral antigen. However, man-made synthetic versions of antibodies are available that can be injected to fight infection. For example, Interferon alpha-2b is a commonly used interferon to treat chronic hepatitis B infection.

Different genotypes of patients having hepatitis B have different responses to interferon therapy. It has been observed that HBV genotype B has a better response to interferon-alpha therapy. Older studies found interferon therapy and Polyethylene Glycol (PEG)- Interferon therapy (IFN) to have the only average antiviral capacity and have some evident side effects.

However, a study claimed IFN-alpha to be therapeutically effective due to its potent antiviral and immunomodulatory properties. Furthermore, long-term analysis of alpha-interferon treatment revealed that the therapy leads to remission of the virus and improvements in liver structure (histology).

Modern Research

According to modern research, interferon-alpha has evident anti-viral properties, but this function is compromised in the presence of HBV. This effect is due to the interaction between IFN stimulated genes (ISG) and HBV proteins. Thus, small molecules must be designed that interfere with this communication and enhance the efficacy of therapy.

According to a new switch study, chronic hepatitis B patients can attain evident HbsAg loss by switching to PEG-IFN-alpha-2a therapy.

In addition to interferon therapy (PEG-IFN), neucleot(s)ide analogs (NUCs) are also utilized to decrease the viral load further. The best antiviral drugs used in combination with NUCs include:

    • Tenofovir disoproxil fumarate
    • Tenofovir alafenamide
    • Entecavir

Interferon therapy can have some side effects. However, using it with NUCs has better results in hepatitis B patients.

3) Liver Transplant

A liver transplant is the only option left if the virus has extensively damaged the organ. It is well-documented that a liver transplant is the only option when the following changes have occurred:

    • There are severe acute hepatitis flares
    • Decompensated cirrhosis of the liver has taken place
    • Hepatitis B has converted into hepatocellular carcinoma

Lifelong antiviral therapy is recommended after liver transplantation. This is because recurrent hepatitis infection can significantly impair graft and compromise patient survival.