What are the Hepatitis B Treatments?

Hepatitis B is caused by a virus and leads to inflammation in the liver. An acute case of hepatitis B requires no treatment. Chronic hepatitis B requires treatment to slow or stop damage to the liver. According to the Centers for Disease Control and Prevention between 800,000 and 1.4 million people are living in the U.S. with chronic hepatitis B, and an estimated 3,000 die each year. Treatment for hepatitis B is with either antiviral medication or interferons, or if necessary liver transplant.

Interferon Treatment

• Interferon treatment for hepatitis B boosts the body's immune system so that it can adequately fight off infection. Physicians prescribe interferons when the alanine aminotransferase or ALT levels are elevated. The liver releases ALT when liver cells die, so elevated ALT levels mean the immune system has recognized the infection and is attacking and killing infected liver cells.

  Conventional or interferon alpha-2b is approved for both adults and children, while pegylated interferon is approved for use in adult patients with hepatitis B.

  When the ALT levels are elevated and the virus level is low, injections of interferon are most effective. Pegylated interferon, a once a week time-release medication, is especially effective in boosting the immune system compared to conventional interferon.

Antiviral Treatment

• The FDA approves of four antiviral drugs, but only one, lamivudine, is approved for both children and adults. The other three antivirals for hepatitis B treatment are adefovir, entecavir and telbivudine. Antivirals prevent the virus from replicating in the liver. With a lower viral load, the liver sustains less damage.

  Lamivudine is a daily pill or oral solution and is considered safe. It has few side effects and is effective for as long as it is taken. When treatment is stopped, the ALT levels rebound. One significant downside to the treatment is that after four years, 60 percent of hepatitis B patients develop lamivudine-resistant hepatitis B.

  Doctors frequently switch patients who develop lamivudine-resistant hepatitis B to adefovir, which has the viral fighting ability but no resistance problems.

  Entecavir appears to work in a longer, sustained fashion even when patients stop taking the drug. Resistance can develop, typically when a patient has developed lamivudine resistance already.

  Telbivudine, a newer drug approved in 2006, has shown greater ability to decrease ALT levels and to lower the viral load than the other treatments currently approved. It also has no known significant side effects or viral resistance.

  Tenofovir was approved in 2008 and has been previously used to treat HIV. It is taken as a daily 300 mg tablet.

  Some newer drugs are in clinical trials and show promise, including emtricitabine and clevudine.

Liver Transplant

• Liver transplantation is the only treatment or hope for end-stage liver disease. There is a recurrence rate of hepatitis B of 80 percent and a one-year survival rate of just 50 percent. However, when treated with hepatitis B immune globulin HBIG or antiviral medication such as lamivudin,e liver transplant recipients have only a 30 percent recurrence of hepatitis B and a similar boost in the survival rate.