Hepatitis B - Treating hepatitis B

If you are diagnosed with hepatitis B, it is likely that your GP will refer to you a specialist, usually a hepatologist (a liver specialist).

Most people tend to be free of symptoms and recover completely within a couple of months, never going on to develop chronic hepatitis.

There is usually no specific treatment for acute (short-term) hepatitis B. Unless your symptoms are particularly severe, you should be able to manage them at home.

You can take over-the-counter painkillers such as paracetamol and may be prescribed codeine if the pain is more severe. Nausea (feeling sick) can often be controlled with a medication called metoclopramide.

If you are diagnosed as having a hepatitis B infection, you will be advised to have regular blood tests and physical check-ups.

Once your symptoms get better, you will need further testing to check that you are free of the virus and have not developed chronic hepatitis B.

Treating chronic hepatitis B

If you have chronic hepatitis B, you will be symptom-free for much of the time. However, you may need to take medication to prevent liver damage, possibly for many years.

There are now very effective medications that can suppress the virus over many years. These can slow down the damage being done to the liver, allowing the body to repair itself. However, it is unusual for this treatment to clear the virus permanently.

You may also need regular tests to assess the state of your liver. This might include blood tests, an ultrasound or a FibroScan, which measures liver stiffness, and possibly a liver biopsy. This is to assess whether the virus is currently damaging the liver and how much damage has been done.

The medication used to treat chronic hepatitis B will depend on whether there is evidence of ongoing liver damage. In some patients, their immune system suppresses the virus without causing damage.

If your liver is shown to be working fairly well, the first treatment offered will be a drug called peginterferon alfa 2-a.

Depending on the results of monitoring tests, you may need to take different medication at a later date. If your liver is showing signs of failing, or peginterferon alpha-2a is not suitable or not working for you, your doctor is likely to offer antiviral medication. This is usually tenofovir or entecavir.

In some cases, treatment works well and it is possible for your immune system to regain control over hepatitis B. In this case your doctor may advise you to stop taking medication altogether.

It is very important that you take your treatment as prescribed, even if you feel well or are finding side effects troublesome, as stopping treatment early can lead to drug resistance and could also lead to liver damage. Always speak to your doctor before you come off these drugs.

Peginterferon alfa-2a

Peginterferon alfa-2a can be used in the treatment of hepatitis B where there are very high levels of the virus. It stimulates the immune system (the body's defence against infection) to attack the hepatitis B virus and regain control over it.

The medication is usually given by injection once a week over 12 months. Your doctor will be able to tell whether the treatment is likely to work for you during tests at three and six months. They may suggest an alternative antiviral if the treatment is not working.

It's common to experience flu-like symptoms such as a high temperature and muscle and joint pain after beginning to take peginterferon alfa-2a. Taking paracetamol can often help relieve these side effects and they should get better with time.

However, in some people peginterferon alfa-2a can cause a wide range of persistent and unpleasant side effects. This may mean that treatment needs to be withdrawn and an alternative antiviral will need to be used.

If you start to feel any uncomfortable side effects, discuss this with your doctor or nurse.

Tenofovir

Tenofovir is available in tablet form and should usually be taken with food.

Side effects of tenofovir include:

diarrhoea
feeling sick
being sick
skin rash
feeling weak
dizziness
in rare cases, kidney problems

Entecavir

Entecavir is available as a tablet.

Side effects of entecavir include:

being sick
feeling sick
insomnia
dizziness

If you feel dizzy, avoid driving or using tools or machinery.

Lactic acidosis

A rare but serious side effect that can occur with tenofovir and entecavir is that the medication can cause a build-up of lactic acid in your blood. This is known as lactic acidosis and is potentially serious if left untreated.

Initial warning signs and symptoms of lactic acidosis include:

feeling very weak or tired
having unusual muscle pain
breathing difficulties
having stomach pain, along with feeling or being sick
feeling unusually cold, especially in your arms and legs
feeling dizzy or lightheaded
having a fast or irregular heartbeat

If you experience any of these warning signs and symptoms, contact the doctor in charge of your care for advice.

Preventing the spread of hepatitis B

While the medications mentioned above can slow the spread of chronic hepatitis B and hopefully prevent complications such as cirrhosis, they cannot cure the infection. This means you can still pass hepatitis B on to other people.

You should avoid having unprotected sex with someone, including anal and oral sex, unless you are sure they are immunised against hepatitis B.

If you are an injecting drug user, never share your needles or other injecting or preparation equipment with other drug users.

You should also take some sensible precautions to avoid the spread of infection, such not sharing toothbrushes or razors with other people.