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    Treatment

    During the acute phase of hepatitis B, most people do not require treatment. Symptoms vary from being very obvious with jaundice, nausea and malaise or there may be very vague or mild symptoms, including feeling more tired than usual and needing plenty of rest. Indeed, many people are infected in childhood and are often not aware that they have acquired hepatitis B and only fi nd out when they develop problems caused by chronic hepatitis B. For a very small minority of people, there are serious symptoms from acute hepatitis B, called fulminant hepatitis which requires hospital treatment. For the majority, the symptoms resolve and the person can ‘clear’ the infection, usually within six months, meaning they are no longer infectious and may never be infected again (they become ‘immune’).

    Chronic hepatitis B often requires treatment to stop or limit the activity of the virus damaging the liver and the replication (duplication) of the virus. When you are diagnosed with hepatitis B, it is usually best to be referred, by your GP or another healthcare professional, to a liver specialist (called a hepatologist) or a specialist in digestive diseases (a gastroenterologist) or an infectious disease specialist who can assess how long you have had the virus, the activity of the virus (whether it is replicating), and the extent of any liver damage. This information will help the specialist recommend the appropriate treatment for you and measure its effectiveness.

    If treatment is needed, two types of drug therapy are used.

    The first is interferon. This is similar to interferon that your body’s immune system produces to fi ght infection. It is used to boost your immune system to help prevent the virus from growing and causing more liver damage.

    The form of interferon most commonly used is ‘pegylated interferon’. This needs to be injected once a week. You should be shown how to inject yourself using a technique similar to that used to treat diabetes. Some people are on another version called ‘interferon alfa’ that needs to be injected three times a week.

    There are a number of different ‘antiviral’ treatment regimes and you should discuss these with your doctor. Most treatment regimes involve either one potent drug (such as entecavir, adefovir, telbivudine, tenofivir or lamivudine) or a combination of drugs (such as tenofovir plus lamivudine).

    It is very important that once treatment is started it is continued for many years. Stopping treatment for even a short period of time can lead to ‘drug resistance’, when the drugs stop working. It is therefore very important that you ensure that you always have an adequate supply of tablets along with a reserve supply, in case you run out of tablets or lose your main supply. Once you have started treatment you should never stop your treatment without discussion with your doctor. 

    Some of these medications are being reviewed by a Government body called NICE, which looks at their clinical and cost effectiveness. NICE has given guidance on several of the medications, recommending how the NHS should use them for the treatment of hepatitis B, including peginterferon alfa-2a, lamivudine, entecavir and adefovir.

    Other medications are being investigated in clinical trials for use in combination with others or alone. Most of these are in tablet or capsule form and do not require injection.

    Ask your specialist or medical advisor for further information about current and emerging antiviral treatments.

    Will my treatment have side effects?
    Interferon produces side effects in many people, especially in the early stages of treatment. The side effects vary from person to person. Some people get flu-like symptoms such as:  

    • nausea (feeling sick)  
    • headaches  
    • fever  
    • tiredness  
    • muscle aches  
    • depression.

    This is not a full list of side effects. Often, flu-like symptoms can be helped by taking paracetamol before the interferon.

    People who have very bad side effects may not be able to take a full dose or a full course. Because of the different side effects, blood tests are needed during treatment.

    It is important to go for regular check-ups so that any side effects can be carefully monitored.  
    Lamivudine seems to be better tolerated than interferon.  

    Will the treatment work?  
    Not everyone responds well to treatment with interferon. Some people get better to start with, but become unwell again as soon as treatment stops. In some people, the virus develops resistance to the treatment and so the treatment stops working effectively. Your doctor may prescribe another treatment to combat this resistance. Treatment generally does not offer a cure, but it does help delay or prevent cirrhosis for people who respond.

    People who were born with the virus because their mother was a carrier tend to respond less well, but treatment may still be recommended to help prevent cirrhosis developing and to reduce the chance of the infection being passed on.  

    Liver transplantation  
    For some people with cirrhosis who develop life threatening complications, liver transplantation is an option. Although this is a major operation, 88 out of 100 people survive.

    The virus does infect the new liver and can sometimes cause severe disease after some years.