Treatment of Hepatitis B
Acute hepatitis B does not require specific treatment, since 95% of adults recover spontaneously. It is important to remember that the contacts of people with acute hepatitis B should be assessed and possibly vaccinated. Acute hepatitis B is highly contagious, so measures should be taken to prevent transmission.
People who develop chronic hepatitis B should be evaluated by a physician experienced in the management of this disease (gastroenterologist or hepatologist). Treatment decisions are individualized. The goal of treatment is to keep a lid on virus replication to prevent progressive liver damage.
General: Patients with chronic hepatitis B should be vaccinated against hepatitis A if they are not immune. Avoid alcohol and medications that are not clearly necessary. Overweight and obesity may be factors that contribute to liver damage (see diet). In patients with cirrhosis usually recommended an ultrasound and measure levels of alpha-fetoprotein every 6 months.
Antiviral treatment: There are at least 5 treatment options for chronic hepatitis B, including interferon and antivirals lamivudine, adefovir, entecavir and clevudina. The decision on when to start treatment and what type of drug use should consider all clinical and laboratory background of the patient and is usually a joint decision between doctor and patient.
Interferon: Alpha interferon is a substance normally produced by immune cells of the body against infections, particularly viral. This medication is used as a subcutaneous (under the skin). In recent years there has appeared a formulation called pegylated interferon or peginterferon that can be administered once a week. The duration of treatment is between 4 and 12 months. This treatment can have many side effects, but has the advantage that when a response is achieved, it is usually sustained over time. Do not use when the patient has decompensated cirrhosis.
Lamivudine: A medicine that is taken orally in doses of 100 mg per day. This compound directly inhibits the virus by interfering with viral replication mechanisms. It is a well tolerated drug, with almost no side effects. The major drawback of this treatment is that needs to be used for long periods of time and may cause the emergence of resistant virus (YMDD mutation in the polymerase region), which are associated with lack of response to treatment.
Adefovir: It works similar to lamivudine, inhibiting the viral polymerase. It is a newer drug than lamivudine. It is generally well tolerated, but has the potential to damage kidney function, so that it monitored with periodic examinations. It is used in doses of 10 mg per day. Its advantage over lamivudine is that the possibility of generating resistant mutants is much lower.
Entecavir: a potent antiviral drug whose main advantages are its potent antiviral activity and low development of resistance. It is well tolerated. Because it has been shown to have activity against HIV virus should not be used in people co-infected with HIV if they are not with antiretroviral therapy (see co-infection hepatitis B-HIV).
Clevudina: This is the newest oral antiviral viral polymerase inhibitors, however, no antiviral potency seems to be superior to adefovir and entecavir.
Other antivirals: A series of new drugs are in advanced stage of development or approved for use against HIV, including emtricitabine, famciclovir, telbivudine, tenofovir, and others.
Liver transplant: A treatment option for some patients when established decompensated cirrhosis. Liver transplantation for people with hepatitis B is more complex than for other indications, requiring expensive treatments to control virus replication after transplantation.
Prognosis of Hepatitis B
The evolution of the disease is quite variable. There are probably genetic factors that are associated with different ability to maintain viral replication under control. The amount of damage is also associated with age (children often have high viral replication with little liver damage), sex (usually the disease progresses faster in men than women), alcohol consumption and presence of other viruses (such as viruses Hepatitis D and C).
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