What is hepatitis and how does it affect the liver. What are the different types of hepatitis viruses. How is hepatitis diagnosed and treated. What are the symptoms of hepatitis to watch out for. When should you seek medical help for hepatitis symptoms.

What is Hepatitis and How Does It Affect the Liver?

Hepatitis is a term used to describe inflammation of the liver. This condition can have various causes, including viral infections, chemical exposure, excessive alcohol consumption, certain medications, genetic disorders, or an overactive immune system attacking the liver (autoimmune hepatitis).

The course of hepatitis can be either acute or chronic:

• Acute hepatitis: Develops suddenly and typically resolves within a few months
• Chronic hepatitis: A long-term condition that can lead to progressive liver damage over time

Understanding the impact of hepatitis on liver health is crucial for early detection and proper management of the condition.

The Five Main Types of Viral Hepatitis: A Comprehensive Overview

There are five primary viruses responsible for causing different forms of viral hepatitis: A, B, C, D, and E. Each type has unique characteristics and transmission routes:

Hepatitis A

Hepatitis A is primarily a food-borne illness that can spread through contaminated water and unwashed food. It is highly contagious, especially among children, but is generally the mildest form of viral hepatitis. Most cases resolve completely within six months and rarely cause long-term liver damage.

Hepatitis B

Hepatitis B transmission occurs through exposure to contaminated blood, needles, syringes, or bodily fluids. It can also be passed from mother to baby during childbirth. Hepatitis B is a chronic condition that may lead to long-term liver damage, cirrhosis, or liver cancer after many years of infection.

Hepatitis C

Hepatitis C is transmitted through infected blood or from mother to newborn during childbirth. Like hepatitis B, it can lead to liver cancer and cirrhosis in the long term if left untreated.

Hepatitis D

Hepatitis D is unique in that it only affects individuals who are already infected with hepatitis B. This co-infection can lead to more severe liver disease and faster progression of liver damage.

Hepatitis E

Hepatitis E is predominantly found in Africa, Asia, and South America. It is typically transmitted through contaminated water and can be particularly dangerous for pregnant women.

Non-Viral Causes of Hepatitis: Exploring Other Risk Factors

While viral infections are the most common cause of hepatitis, several other factors can lead to liver inflammation:

• Alcohol abuse: Excessive alcohol consumption can cause alcoholic hepatitis
• Medications: Certain drugs, even those considered generally safe, can be toxic to the liver when taken in excess or high doses (drug-induced hepatitis)
• Autoimmune disorders: The body’s immune system may mistakenly attack liver cells, causing autoimmune hepatitis
• Genetic disorders: Some inherited conditions can lead to liver inflammation

It’s important to note that even common medications like acetaminophen (Tylenol) and vitamin A supplements can cause hepatitis if taken in excessive amounts. Always consult with a healthcare professional about appropriate dosing, especially for children.

Recognizing the Symptoms of Hepatitis: When to Be Concerned

Hepatitis can present with a range of symptoms, some of which may be subtle in the early stages. Common signs and symptoms include:

• Malaise (general feeling of discomfort or illness)
• Abdominal tenderness, especially in the upper right quadrant
• Fatigue
• Jaundice (yellowing of the skin and the whites of the eyes)
• Dark-colored urine
• Light-colored stools
• Abdominal pain
• Nausea, with or without vomiting
• Abdominal swelling due to fluid retention

If you or your child experience any of these symptoms, particularly jaundice or persistent fatigue, it’s essential to seek medical attention promptly.

Diagnosing Hepatitis: The Path to Accurate Identification

Diagnosing hepatitis involves a combination of physical examination, laboratory tests, and imaging studies. The diagnostic process typically includes:

1. Physical examination: A healthcare provider may check for liver enlargement or tenderness
2. Blood tests: These assess liver enzyme levels and screen for the presence of hepatitis viruses
3. Ultrasound: Imaging of the liver can reveal changes in its structure or size
4. Liver biopsy: In some cases, a small sample of liver tissue may be taken to confirm inflammation and assess the degree of liver damage

Early and accurate diagnosis is crucial for determining the appropriate treatment approach and preventing further liver damage.

Treatment Approaches for Hepatitis: Managing Symptoms and Preventing Complications

While there is no cure for hepatitis once it occurs, treatment focuses on several key objectives:

• Preventing further liver damage
• Reversing existing damage when possible
• Providing symptom relief
• Suppressing viral replication in cases of viral hepatitis

Treatment approaches vary depending on the type and cause of hepatitis:

Acute Hepatitis

Most cases of acute hepatitis resolve on their own over time. Treatment typically involves supportive care, including rest, proper nutrition, and avoiding alcohol and hepatotoxic substances.

Chronic Viral Hepatitis

For chronic hepatitis B and C, antiviral medications may be prescribed to suppress viral replication and prevent liver damage. In some cases, interferon therapy may be recommended.

Autoimmune Hepatitis

Treatment for autoimmune hepatitis often involves immunosuppressive medications to control the overactive immune response and prevent further liver damage.

Alcoholic Hepatitis

The primary treatment for alcoholic hepatitis is complete abstinence from alcohol. Additional supportive care and nutritional support may be necessary.

In severe cases of hepatitis that lead to liver failure, liver transplantation may be considered as a last resort.

Preventing Hepatitis: Vaccination and Lifestyle Modifications

Prevention plays a crucial role in reducing the incidence of hepatitis. Key preventive measures include:

• Vaccination: Vaccines are available for hepatitis A and B. It’s recommended that children and adults who haven’t been previously vaccinated receive these immunizations.
• Safe practices: Using clean needles, practicing safe sex, and avoiding sharing personal items like toothbrushes or razors can help prevent the spread of hepatitis B and C.
• Food and water safety: Proper hygiene, including handwashing and consuming clean water and properly prepared food, can help prevent hepatitis A and E.
• Alcohol moderation: Limiting alcohol consumption can reduce the risk of alcoholic hepatitis.
• Medication awareness: Following prescribed dosages and being aware of potential drug interactions can prevent drug-induced hepatitis.

It’s important to note that there are currently no vaccines available for hepatitis C, D, and E. For these types, prevention relies heavily on avoiding exposure to contaminated blood and practicing good hygiene.

When to Seek Medical Help: Recognizing the Red Flags

Knowing when to seek medical attention is crucial for managing hepatitis effectively. You should contact a healthcare provider if you or your child experience:

• Persistent fatigue that doesn’t improve with rest
• Jaundice (yellowing of the skin or eyes)
• Abdominal pain, especially in the upper right quadrant
• Dark urine or light-colored stools
• Unexplained weight loss
• Nausea and vomiting that interferes with eating or drinking

Early intervention can help prevent complications and improve outcomes for individuals with hepatitis. Don’t hesitate to reach out to a healthcare professional if you have concerns about potential hepatitis symptoms.

Understanding hepatitis, its various forms, and associated risk factors is essential for maintaining liver health and overall well-being. By recognizing the symptoms, seeking timely medical care, and taking preventive measures, individuals can significantly reduce their risk of developing serious liver complications associated with hepatitis.

Hepatitis | Johns Hopkins Medicine

Overview

Hepatitis is a general term used to describe inflammation of the liver. Liver inflammation can be caused by several viruses (viral hepatitis), chemicals, drugs, alcohol, certain genetic disorders or by an overactive immune system that mistakenly attacks the liver, called autoimmune hepatitis. Depending on its course, hepatitis can be acute, which flares up suddenly and then goes away, or chronic, which is a long-term condition usually producing more subtle symptoms and progressive liver damage.

Types of Hepatitis

There are five viruses that cause the different forms of viral hepatitis: hepatitis A, B, C, D and E. Hepatitis A is mostly a food-borne illness and can be spread through contaminated water and unwashed food. It is the easiest to transmit, especially in children, but is also the least likely to damage the liver and is usually mild and is completely resolved within six months. Hepatitis B can be transmitted through exposure to contaminated blood, needles, syringes or bodily fluids and from mother to baby. It is a chronic disorder and in some cases may lead to long-term liver damage, liver cancer and cirrhosis of the liver after many years of carrying the virus. Hepatitis C is only transmitted through infected blood or from mother to newborn during childbirth. It too can lead to liver cancer and cirrhosis in the long term. Hepatitis D is only found in people who are also infected with hepatitis B. Hepatitis E is predominantly found in Africa, Asia and South America. Certain generally safe medications can be toxic to the liver and cause hepatitis (drug-induced hepatitis) when taken in excess or in very high doses. These include acetaminophen (Tylenol) and even vitamin A. Check with your pediatrician about appropriate dosing for your child.

• Autoimmune hepatitis

• Hepatitis A

• Hepatitis B

• Hepatitis C

• Hepatitis D

• Hepatitis E

• Neonatal hepatitis

Symptoms

• Malaise

• Abdominal tenderness, especially in the upper right corner

• Fatigue

• Jaundice (yellowing of the skin and the white portion of the eyes)

• Dark-colored urine

• Lightly colored stools

• Abdominal pain

• Nausea with or without vomiting

• Abdominal swelling due to fluid retention

Diagnosis

The following are required to diagnose hepatitis:

• Physical exam, which may or may not reveal a swollen, enlarged liver

• Blood tests to check liver enzymes that are elevated when the liver is damaged or infected, as well as blood tests to check for the presence of any of the five viruses causing hepatitis

• Ultrasound of the liver to detect any changes

• Liver biopsy to confirm suspected inflammation when other tests are inconclusive and to determine the exact degree of liver damage

Treatment

To prevent infection, children — or anyone who has not been previously vaccinated — should be vaccinated against hepatitis B and hepatitis A. There are no vaccines against hepatitis types C, D and E. There is no cure for hepatitis once it occurs. Treatment focuses on preventing further damage to the liver, reversing existing damage if possible and symptom relief. Most cases of acute hepatitis will resolve over time. In autoimmune hepatitis, certain medications may be used to help keep the overactive immune system in check and prevent further attacks on the liver.

When to Call for Help?

If your child develops symptoms suggestive of liver inflammation, as listed above, call your pediatrician.

Basics

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  Alcoholic Hepatitis
• 
  Autoimmune Hepatitis
• 
  Drug-Induced Hepatitis
• 
  Hepatitis A and E
• 
  Hepatitis B
• 
  Hepatitis C
• 
  Hepatitis D
• 
  Hepatitis in Children
• 
  Neonatal Hepatitis


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ABCs of Hepatitis: From Chronic to Curable, What You Need to Know

November 26, 2021

This article was medically reviewed by Dr. Fazila Aslam.

Though not uncommon, viral hepatitis is a serious illness that is often less understood than other infectious diseases. Hepatitis A, B, and C are types of viral hepatitis and share some common symptoms, but they infect different patient populations. The different strains are caused by different viruses and are transmitted and treated in different ways. Each hepatitis variant must be identified by a blood test so it can be properly treated, and viral hepatitis should never be ignored as it can cause serious health consequences. Learn more about the ABCs of Hepatitis in this article so this infectious disease is more easily understood and identified early.

What is Viral Hepatitis?

From the Greek hēpatos for liver and -itis for inflammation, hepatitis primarily affects the liver, one of the body’s largest organs that is essential to good health. In a recent interview, Dr. Fazila Aslam of ID Care described a healthy liver function as one that “rids the body of toxins, prevents and fights infections, regulates blood sugar, and processes nutrients. As such, it’s very important.”

Hepatitis can happen because of certain medications, toxins, heavy alcohol use, and some medical conditions, but the communicable forms in the U.S. are due to viruses known by their letter designations: A, B, C, D, and E. Hepatitis A, B, and C are the most common in the U.S.

ABCs of Hepatitis: Is it Curable?

The ABCs of Hepatitis reveal that the disease is either manageable or curable depending on which type of hepatitis a person has. Hepatitis A usually resolves itself within a few months; hepatitis B can be suppressed with antiviral drugs until it leaves the body; and hepatitis C can be cured outright with medication.

Dr. Aslam advises that “preventing the disease is always preferable to curing it after infection, so vaccination for type A and B are important, and avoiding contact with infected people and contaminated body fluids, food, and water will inhibit the spread of all forms of viral hepatitis.”

Hepatitis A Virus (Hep A or HAV)

Hepatitis A or HAV is virus that spreads through the oral-fecal route. Contaminated food can infect you, or if you travel to an area where it’s very common, you could get it from contaminated water. If somebody in your home has it, you can get it through household contact. It’s also common in men who have sex with men, so there is a risk of sexual transmission.

The incubation period for HAV is roughly a month, and most of the time, it resolves itself. Fewer than 1% of cases will go on to develop fulminant, or severe, hepatitis, which can result in very bad liver disease and damage.

There’s no antiviral medicine that can cure hep A, so treatment focuses on reducing symptoms via fluids and bed rest.

Prevention is the ideal strategy and easily accessible through the HAV vaccine, delivered in two doses, six to 12 months apart. “Everyone from 12 months to 60 years of age should get the vaccine,” said Dr. Aslam, “it’s by far the best way to avoid problems with this disease.”

Hepatitis B Virus (Hep B or HBV)

Hepatitis B or HBV is a virus that impacts about a million people in this country. The incubation period is between 3 and 6 months, but because it can be asymptomatic, most people do not know when they have it. While some people will recover from hep B, for others it becomes a chronic disease.

HBV spreads through contaminated blood or body fluids, so you can get it from sexual contact, infection passed from childbirth, and household contacts such as the sharing of razor blades. HBV can live outside the body for up to seven days, remaining infectious and it is highly contagious.

There is treatment for hep B, including drugs aimed at suppressing the virus and monitoring to protect the liver, but there is no cure. The medicine suppresses the virus to prevent liver damage such as cirrhosis or liver cancer. Regular ultrasounds can help manage the disease to prevent it from progressing and to detect any cancer in the early stages.

“There is a lot of work being done in the HBV arena, and the hope is that, in the next two to five years, a treatment will become available,” Dr. Aslam said.

Prevention comes in the form of 3 shots at 0, 1, and 6 months apart. Dr. Aslam recommends that “everybody up to the age of 60 should be vaccinated for hepatitis B.”

Hepatitis C Virus (Hep C or HCV)

Hepatitis C or HCV is the most common type of hepatitis and affects approximately 1% of the U.S. population or more than 3 million people, with more than half remaining undiagnosed. “Many people have it and don’t know because hepatitis C can lie dormant for years and emerge as a chronic disease later in life,” explained Dr. Aslam. “It is the number one reason for liver transplants in the U.S., and the number one cause of liver cancer. The big news, however, is that hep C is now curable through a combination of pills taken once a day for eight to 12 weeks. “Because hepatitis C is a primary cause of liver transplants — which are major, resource-intensive operations — being able to stop the disease before it reaches that stage removes a large burden from the whole healthcare system,” Dr. Aslam said. “Treating this disease without a liver transplant represents a big advance.”

Unfortunately, there is still no vaccine for hep C, so it continues to spread mostly through contaminated blood products. Risk factors include sharing needles, using IV drugs, undergoing dialysis treatments, and having received a blood transfusion or organ transplant prior to 1992, when hepatitis screening of donated blood went into effect. Sexual contact is not a prominent route of infection, but it can sometimes happen.

ABCs of Hepatitis: What is Acute vs. Chronic

An important fact about the ABCs of Hepatitis is that acute hepatitis refers to inflammation of the liver and liver damage that happens over the course of less than six months, and it is most associated with hepatitis A. When patients recover, their liver function blood tests return to normal. Hepatitis B and C cause mostly chronic disease, which produces symptoms and liver damage over longer than six months.

Hepatitis Symptoms in Men and Women

For both men and women, viral hepatitis can cause nausea, vomiting, abdominal pain, and jaundice, which is yellowish discoloration of the skin and the whites of the eyes. According to Dr. Aslam, “you can have fevers, your urine will be dark, your stool will be pale, you can have joint pain, and with hepatitis B and C, you can develop a rash. Sometimes the B and C strains can affect the kidneys, as well.” If advanced liver disease develops, other systemic complications may crop up, such as blood clotting difficulty and fluid retention in the belly.

If you experience these ongoing symptoms with no other obvious cause, talk to your doctor about getting tested for viral hepatitis. Early detection and treatment offer the best chance of a speedy recovery. ID Care has a team of infectious disease experts that specialize in viral hepatitis diagnosis and treatment to ensure optimal health outcomes.

ABCs of Hepatitis: Who is Most at Risk?

The ABCs of Hepatitis reveal that for hep A, those most at risk are travelers to areas where the disease is prevalent.

For hep B, high-risk groups include homeless people, men who have sex with men, incarcerated people, and drug users. Having multiple sex partners or unprotected sex can also be a risk. Blood products can transmit the disease, but not so much in the U.S., due to routine screening of donated blood.

“For hepatitis C in the U.S.,” Dr. Aslam said, “IV drug use and needle sharing are the big causes. If you got a blood transfusion or an organ transplant before 1992, when hepatitis virus screening began, you should get tested because you are at higher risk.”

Prevalence of Hepatitis in USA and New Jersey

In its 2019 Viral Hepatitis Surveillance Report, the CDC estimates that 37,700 acute cases of HAV occurred, as well as 20,700 cases of HBV, and 57,500 cases of HCV. Between 2015 and 2019, hepatitis A infections increased by a whopping 1,325%. Roughly a million people in the U.S. are currently living with the hepatitis B virus, and about three million have hepatitis C. Because viral hepatitis transmission correlates with illicit drug use, in areas and age groups where opioid use is high, rates of hepatitis are also elevated.

Dr. Aslam explained that “the focus for us is on hepatitis C, mostly because we can treat it, cure it, and eliminate it.” While this disease is common in New Jersey, the state doesn’t rank in the CDC’s top 10 according to incidence.

ABCs of Hepatitis: How it Spreads

Know how hepatitis spreads is a key to understanding the ABCs of Hepatitis. Hepatitis A moves mostly through the oral-fecal route or through contaminated food and water, commonly in areas where the disease is prevalent. Imprisoned people, homeless people, and those living in generally compromised conditions are at higher risk. The disease can move through day-care centers and schools as well.

Hepatitis B is contagious via contact with contaminated body fluids. It could be sexual contact, or through blood or the sharing of needles. High-risk populations include people on dialysis, and babies born to mothers with the disease (known as vertical transmission.)

Hepatitis C is mostly a blood-borne infection, so the risk is heightened during IV drug use, unsanitary tattoo application, and passing it on through childbirth. Sexual transmission occurs, but rarely. Those who’ve had blood transfusions or organ transplants before July of 1992 should also be screened for hep C.

Dr. Aslam advises that “the sexual transmission of hepatitis is most common with the A and B strains, but those who are HIV positive and already relatively immunosuppressed can be at high risk for catching any viral hepatitis and should take extra precautions to avoid infection.”

Preventing Viral Hepatitis

Without question, the best way to prevent infection from hepatitis A or B is to get vaccinated. While there is no vaccine for hepatitis C yet, all hepatitis spread can be reduced by understanding where the virus lurks – whether in blood, other body fluids or on surfaces – and employing these common infection control practices:

• Regularly wash your hands, particularly before cooking or eating food and after using a toilet.
• Avoid direct contact with infected people, including sexual contact.
• Infected people should not prepare food for others.
• When travelling to places with hepatitis outbreaks, follow local safety precautions.

Vaccines are best administered in the offices of infectious disease specialists like those at ID Care but can sometimes be obtained through pediatricians or primary care doctors. Dr. Aslam recommends first checking with your doctor, because the vaccines require enhanced storage techniques, and not every general practitioner or pediatric office will keep them in stock. “At ID Care, we always have some on hand and have the expertise to screen and evaluate every patient properly,” she added.

How is Viral Hepatitis Diagnosed and What is a Hepatitis Panel?

“To diagnose this disease, we use a pretty straightforward blood test,” said Dr. Aslam. “It’s known as a hepatitis panel, and it checks for hepatitis A, B, and C antibodies. It’s fairly effective and not very invasive.”

Testing is indicated if someone has gastrointestinal symptoms like nausea, vomiting, and abdominal pain, or if the patient is jaundiced or is in the hospital for some other reason and lab tests show abnormal liver function. “We do a hepatitis panel to make sure a patient is not suffering from something other than what brought them in,” Dr. Aslam said. “It’s mostly done as a part of a general work-up if the patient doesn’t feel well and their liver function is not that great.”

How Does ID Care Diagnose and Treat Viral Hepatitis Patients?

“We see all three main kinds of hepatitis A, B, and C in our offices,” said Dr. Aslam, “mostly due to referrals from hospitals, primary care physicians, or specialists. For hepatitis B, we have oral medications that suppress the virus and keep it at bay. Then we do serial blood tests and ultrasounds to monitor and slow the progression of the disease, to prevent liver failure, and to detect liver cancers early. We are very interested in testing asymptomatic people for hepatitis C, because if we cure all who have it, we can eradicate the disease like we eradicated smallpox. That’s really what pushes us toward early diagnosis and aggressive treatment.”

Because ID care has been in the community for such a long time, its specialists are well known among the people they treat. Often friends or family will refer patients to ID Care, but many referrals come from other physicians.

Typically, treatment takes place on an outpatient basis in the ten ID Care practice locations throughout New Jersey. “It’s a complicated process to sort out the different genotypes for hepatitis C,” said Dr. Aslam, “so we run a lot of blood tests before we administer the medicines. The whole system is in place and ready to go at our facility.”

Treating Hepatitis A, B, C: ID Care Infectious Disease Doctors

According to Dr. Aslam, “ID Care’s unique experience treating chronic illnesses like HIV is what sets us apart. We identify the risk factors, diagnose the strains, and do a lot of community teaching where our patients live. Some of the hepatitis patients we’re trying to help are IV drug users. Because of our experience treating people with HIV, we have a lot of community and healthcare connections, and we can help patients get into detox and recovery programs to break habits that raise the risk for hepatitis B and C. ”

Sometimes, the complex antiviral medicines used for hepatitis B and C can interact with other drugs, and some patients are resistant to their effects. Interestingly, some people who have hepatitis B or C along with HIV may be prescribed hepatitis medications that can affect their HIV as well. “If you have both the diseases, a combination treatment is best, otherwise, patients can develop resistance,” warned Dr. Aslam, adding that “close monitoring is key in these cases.”

Difficult, multi-disease scenarios do happen, and according to Dr. Aslam, “ID Care is better trained, equipped, and experienced to detect and address the complications, drug interactions, and side issues like drug dependence, depression, and substance abuse that can interfere with successful treatment. We provide a uniquely high level of care to our patients with viral hepatitis and related problems.”

As New Jersey’s largest infectious disease practice, ID Care is a leader in the prevention and treatment all infectious diseases like hepatitis A, B, and C as well as other serious infections. To learn more, call 908-281-0221 or visit idcare.com to schedule an appointment today with an ID Care infectious disease expert.

Hepatitis A, Hepatitis B, Hepatitis C, Infectious Disease Blog, Infectious Disease Care

Is it possible to cure hepatitis B. How to treat. – “HEPATIT.RU”

Hepatitis B is an incurable chronic lifelong disease. The course of the disease is not accompanied by severe symptoms. It is possible for many years not to suspect the presence of a virus in oneself and only to detect it during a random examination. Sometimes with a long-term illness, there may be joint pain, fatigue, decreased performance, and insomnia. Often patients complain of heaviness in the right hypochondrium.

For the diagnosis of chronic viral hepatitis B, one marker is sufficient – HBsAg positive. It is usually done at any visit to a medical institution, for example, in preparation for surgery, pregnancy, IVF, etc. This indicator means that the hepatitis B virus is present in the liver. It will remain there forever.

However, this does not mean at all that nothing can be done about the virus and irreversible changes in the liver (cirrhosis and primary liver cancer) are inevitable. Viral hepatitis B is a controlled disease , which means if you keep it under control, you can live a long life with a normal healthy liver. Moreover, viral hepatitis B does not always need to be treated with antiviral drugs !

If the virus is detected for the first time, it is necessary to undergo a complete examination in order to obtain complete information about your virus and the state of the liver. Hepatitis B virological markers allow determining the activity and aggressiveness of the virus, the presence of drug resistance mutations in it, counting the amount of the virus in the blood, and determining its genotype.

In addition, it is extremely important to do an analysis for hepatitis D, which can enter the body along with the B virus. This virus is highly aggressive and quickly causes fibrosis in the liver with an outcome in cirrhosis. Treatment of the hepatitis D virus is prescribed immediately upon its detection – with interferon preparations.

The state of the liver is assessed by different methods: Ultrasound, biochemical parameters, elastometry (FibroMax, FibroTest) – degree liver fibrosis according to the METAVIR scale – F0 healthy liver, F4 cirrhosis.
Depending on the results of this survey, different decisions are made:

1. if the virus is not active and does not pose a threat to life, the liver is in good condition, then antiviral treatment is NOT PRESENTED;

2. if the virus is active and the liver is already affected by the virus, the doctor must prescribe antiviral drugs in order to stop the destructive processes in the liver and return it to a healthy state.

In all cases, the patient should be informed about how to control viral hepatitis throughout his life. The main control parameters are the state of the liver according to elastometry data (FibroTest, FibroMax) – that is, the degree of fibrosis, as well as the activity of the virus – its amount in the blood. It is advisable to be under the supervision of a qualified hepatologist who will be able to make the right decisions in time if the situation changes.

Unfortunately, for viral hepatitis B there is no single standard of treatment and decision-making on its appointment. That is why it is so important to be examined in a timely manner and consult a specialist who knows how to treat viral hepatitis B.

Purpose of hepatitis B treatment

Complete removal of the hepatitis B virus from the body is impossible, since the DNA of the virus is integrated into the host genome. At the same time, the virus is not always dangerous and does not always require treatment. Treatment is necessary only if the virus is active and there are changes in the liver that can lead to cirrhosis.

The goal of therapy for chronic hepatitis B (CHB) is to prevent the progression of the disease to cirrhosis, thereby improving the quality and duration of life.

In the presence of cirrhosis, the goal of treatment is to prevent decompensation of cirrhosis and the development of end-stage liver disease, primary liver cancer, and death.

This goal can be achieved with persistent suppression of HBV replication. Parallel suppression of viral replication and reduction of the inflammatory process in the liver reduces the risk of liver cirrhosis and liver cancer.

Treatment regimens and antivirals for the treatment of CHB

There is no single standard treatment for viral hepatitis B. Decisions are made individually depending on the virological parameters and the degree of liver damage.

Currently, there are two different treatment strategies: course use of alpha interferons, including pegylated ones, or nucleoside/nucleotide analogues (ANs).

Nucleoside analogues: lamivudine, telbivudine, entecavir.

Nucleotide analogues: adefovir and tenofovir.

The advantage of treatment with interferons is that the course of treatment is limited to 1 year. In addition, the resistance of the virus to interferon does not develop, and a persistent virological response persists for a long time even after a course of therapy. It is also possible to completely eliminate the virus with the formation of immunity (formation of anti-HBsAg), although this occurs in about 20-30% of cases.

At the same time, a significant drawback of this tactic is serious side effects, as well as the need for subcutaneous administration, which significantly reduce the patient’s tolerance and motivation for treatment.

Interferon preparations are contraindicated in decompensated cirrhosis due to HBV infection, autoimmune disease, as well as in patients with uncontrolled severe depression and psychosis, and during pregnancy.

Entecavir and tenofovir have potent antiviral properties and are characterized by a high genetic barrier to the development of resistance. Their long-term use does not cause the development of resistance mutations (resistance) to the drug in the virus. Therefore, they can be confidently used as first-line monotherapy.

Lamivudine, telbivudine, and adefovir are recommended for the treatment of CHB only when more potent ANs are unavailable or if intolerance to more active drugs develops.

Lamivudine is an inexpensive drug, but long-term monotherapy is very often accompanied by virus mutation and the development of resistance. Adefovir is less effective and more expensive than tenofovir. Resistance to it occurs more often.

Telbivudine is a potent inhibitor of HBV replication, but resistance develops rapidly in patients with high baseline HBV DNA or detectable HBV DNA after 6 months. treatment. The incidence of telbivudine resistance is relatively low in patients with low baseline viremia (< 2 x 108 IU/mL in HBeAg-positive and < 2 x 106 IU/mL in HBeAg-negative patients) who do not have HBV DNA detected after 6 months. therapy.

Course therapy with pegylated interferon

A 48-week course of PEG-IFN therapy is recommended in HBeAg-positive patients. This provides the greatest likelihood of seroconversion with anti-HBe. This strategy can also be applied in HBeAg-negative patients, since this is practically the only way to obtain a stable virological response after completion of antiviral therapy.

The patient should be given full information about the advantages, adverse events, and disadvantages of interferon therapy compared with NA, so that he can participate in the decision on the choice of drug.

Long-term treatment with nucleoside/nucleotide analogues

This strategy is required in HBeAg-positive patients without HBe seroconversion and in HBeAg-negative patients. The same strategy is recommended in patients with cirrhosis, regardless of HBeAg status or HBe seroconversion during treatment. The most potent drugs with an optimal resistance profile, i. e. tenofovir and entecavir, should be used as first-line monotherapy.

With monotherapy with tenofovir and entecavir for 3 years or more, it is possible to maintain virological remission in most patients.

When taking any drug, it is necessary to achieve and maintain a negative level of HBV DNA, confirmed by real-time PCR. In addition, it is necessary to monitor the condition of the liver during treatment0007 FibroTest ).

Since complete elimination of the virus cannot be achieved, lifelong monitoring of virus activity and liver condition is recommended.

Hepatitis C is a dangerous but curable disease

Chronic viral hepatitis C is a widespread disease The number of cases of hepatitis C is increasing every year around the world. The danger of chronic hepatitis C lies in the fact that the disease is asymptomatic and in most cases ends with cirrhosis and liver cancer .

Tests for suspected hepatitis C

Hepatitis C is most often detected during a random examination for hospitalization, when antibodies to the hepatitis C virus are found in the patient’s blood. In this case, antibodies in the blood indicate only a suspicion of an active viral process.

To confirm the diagnosis, it is necessary to pass a test for virus activity by PCR. Only if a virus is detected can antiviral treatment be planned. The goal of treatment is to completely remove the virus from the liver, and not just from the blood, that is, to get sustained virologic response .

Treatment of hepatitis C

Modern antiviral therapy with direct antiviral drugs is very effective. Manufacturers claim a 99% chance of recovery.

However, in actual clinical practice, the chance of recovery may be lower, as the virus is prone to mutations and genetic changes that make it resistant to drugs. Such mutations often occur in long-term illness or in failure of previous antiviral treatment.

The main goal of hepatitis C treatment is to prevent the formation of cirrhosis. At the same time, it should be taken into account that not only viral hepatitis C, but also other concomitant liver diseases can lead to cirrhosis. Therefore, in the presence of concomitant liver diseases, the hepatologist is obliged to treat them before starting antiviral therapy or at the same time.

The course of treatment is only three months, but in case of cirrhosis it can be extended up to six months.

Treatment of hepatitis C without a complete examination and, if necessary, treatment of concomitant liver diseases can only worsen the patient’s health!

Contraindications in the treatment of hepatitis C

To prescribe treatment, it is necessary to undergo an examination to determine the characteristics of the virus and the condition of the liver.

The characteristics of the virus – genotype and viral load – allow you to choose the most effective treatment regimen. An assessment of the state of the liver is necessary to take into account contraindications in therapy.

Contraindications are decompensated class B and C cirrhosis, concomitant liver disease (most often fatty liver and viral hepatitis B), as well as heart and kidney disease when using certain antiviral drugs. The hepatologist must take into account the patient’s individual contraindications to select the safest treatment regimen and control therapy.

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Self-treatment of hepatitis C – dangerous for your life

Modern antiviral therapy with direct-acting antiviral drugs is well tolerated and does not impair the quality of life during therapy. In many patients, this creates the illusion that the disease can be cured on its own without the supervision of a hepatologist.

Without a doctor’s prescription for individual therapy , side effects from taking drugs, up to severe damage to the kidneys and heart, may occur. Also, self-treatment in general may be unsuccessful due to an incorrectly selected therapy regimen.

Clinical experience of treating several thousand patients in our Hepatocenter shows that complications and failures most often occur when:

• the patient refuses to visit a hepatologist
• self-treatment of a patient on the advice of sellers of generics not registered in Russia.

Generics are copies of original drugs, which are often of dubious origin and quality, both of the active substance and excipients. This is dangerous not only because of the lack of treatment results, but also due to the mutation of the virus, which makes the curable disease hepatitis C – incurable due to the formation of drug resistance in the virus.

So, despite the apparent simplicity of the treatment of hepatitis C with direct antiviral drugs, the treatment of the disease is always ambiguous on a number of issues: Whom to treat? How to treat? When to start therapy? What to check before starting therapy? How to control the safety of treatment and take into account all the individual contraindications of the patient? How to announce a complete recovery to a patient after a course of AVT?

Only a qualified specialist, a hepatologist, can give you answers to these questions.