Acute hepatitis B

If you have acute hepatitis B for the first time, you are probably under a doctor's care. You need to get plenty of rest and be closely monitored with blood tests. No special treatment is required at this time.

Chronic hepatitis B

If you have chronic hepatitis B, your doctor will want to do several blood tests to determine the status of your infection.

Non-active forms of chronic hepatitis B infection:

If there is no active form of the virus in the blood

If no virus is detected in the blood, antiviral medications are not helpful because there is no reproducing virus to attack with the drug. This is common in people with chronic hepatitis B, who are experiencing a very low-grade "grumbling" infection that may go on for years. You will want to be monitored closely and stay aware of new research advances.

If the individual is the carrier

If liver tests show normal enzyme levels, it is probably best to watch and wait, because treatments for hepatitis B work optimally only when the liver enzymes are elevated, as this indicates that the immune system is fighting off infection. This carrier state is very common in people from Asia during their early adult years. Some liver damage is occurring despite the normal enzyme levels, and there is still a risk of eventually developing complications of hepatitis B, such as cirrhosis or liver cancer. There may be flare-ups of hepatitis B, with sharp rises in liver enzyme levels and the beginning of symptoms.

Active chronic hepatitis B infection:

If the virus is active and reproducing it is infectious

This is actually the ideal situation for treatment, since the body is fighting the infection and the antiviral treatments can target the virus in its active state. Specific blood tests are usually performed to determine if a treatment should be used.

Treatment options

Presently in Canada there are 2 treatment options:

  • The first involves the use of interferon-alpha, which helps to improve the body's immune response to the hepatitis B virus.
  • The second option are antiviral agents. These include nucleoside analogues (such as lamivudine) or nucleotide analogues (such as tenofovir). Nucleoside/nucleotide analogues act directly on the hepatitis B virus to hinder its replication in the body.

Both medications are generally used for extended periods of time; however, symptoms can come back when medications are stopped. Some people have developed drug resistance with the use of lamivudine. Drug resistance means that the hepatitis B virus has developed survival techniques against lamivudine, thus lowering the effectiveness of the drug.

Stephen Sacks, MD, FRCPC, with updates by the Medbroadcast clinical team