The Palette of HBV Treatments – these are tailored to each patient’s needs
The Anti viral treatments below are only needed by about 20% of Hepatitis B patients, many patients are classified inactive meaning their own bodies are doing the job of controlling Hepatitis B and staying well. The goals and aims of HBV treatment are to lower infectivity and slow liver damage. This is because no drug is effective at removing the virus. Hepatitis B HBsAG on your test result means you are infected but you are a low infection risk and HBeAG means you are infected and the virus is replicating and you are a high infection risk.
Chronically infected individuals with persistently elevated ALT’s, a marker of liver damage, and high e antigen or just HBV viral loads are candidates for therapy. Several medicines treat hepatitis B. If you do not need anti viral treatment, you should be monitored over time, once a year, to know if your hepatitis has become more active. Once you start treatment, you will have regular blood tests to see how well the treatment is working and to detect side effects or drug resistance. Monitoring will continue after finishing treatment to detect signs that the infection has come back.
Each patient may have a different set of needs or treatments according to the factors and their individual health, further these medicines evolve and improve rapidly, being on a trial is quite normal in this field of medicine.
Tenofovir and Entacavir are the most used and effective treatments. A newer more easy on the bone density, vitamin d and calcium levels form of Tenofovir is now also being licensed.
We recommend all Africans taking anti virals for Hepatitis B also take a Vitamin D Supplement.
1. Entecavir — Entecavir (Baraclude®) is generally more potent than lamivudine and adefovir. Resistance to entecavir is uncommon in people who have never been treated with antivirals, but occurs in up to 50 percent of people who have used lamivudine. (See "Entecavir in the treatment of chronic hepatitis B virus infection".)
Entecavir is taken by mouth, at a dosage of 0.5 mg daily for patients who have no prior treatment and 1.0 mg daily for patients who have resistance to lamivudine. Most patients will need long-term treatment to maintain control of the hepatitis B virus.
2. Tenofovir — Tenofovir (Viread®) is more potent than adefovir. Resistance to tenofovir is rare. Tenofovir is taken by mouth, at a dosage of 300 mg daily. Tenofovir is effective in suppressing hepatitis B virus that is resistant to lamivudine, telbivudine, or entecavir. Tenofovir is not as effective in patients with adefovir-resistant hepatitis B. Resistance to tenofovir is uncommon. (See "Tenofovir disoproxil fumarate in the treatment of adults with chronic HBV infection who do not have HIV infection".)
3. Lamivudine — Lamivudine (Epivir-HBV®) is effective in decreasing hepatitis B virus activity and ongoing liver inflammation. It is safe in patients with liver failure and long-term treatment can decrease the risk of liver failure and liver cancer. (See "Lamivudine monotherapy for chronic hepatitis B virus infection".)
Lamivudine is taken by mouth, usually at a dosage of 100 mg/day. The major problem with lamivudine is that a resistant form of hepatitis B virus (referred to as a YMDD mutant) frequently develops in people who take lamivudine long term. Other medicines are available that are less likely to cause resistance.
4. Adefovir — Adefovir (Hepsera®) is an alternative initial choice for people who have detectable hepatitis B virus activity and ongoing liver inflammation. An advantage of adefovir compared to lamivudine is that resistance to adefovir is less likely to develop. In addition, adefovir can suppress lamivudine-resistant HBV. (See "Adefovir dipivoxil in the treatment of chronic hepatitis B virus infection".)
Adefovir is taken by mouth, at a dosage of 10 mg/day, for at least one year. Most patients will need long-term treatment to maintain control of the hepatitis B virus. Adefovir is a weak antiviral medicine, and resistance does occur over time. Other medicines are available that are more potent.
5. Telbivudine — Telbivudine (Tyzeka®) is more potent than lamivudine and adefovir. Resistance to telbivudine is common, and hepatitis B virus that is resistant to lamivudine is also resistant to telbivudine. Telbivudine is taken by mouth at a dosage of 600 mg daily. Other medicines are available that are less likely to cause resistance. (See "Telbivudine in the treatment of chronic hepatitis B virus infection".)
6. Interferon-alpha — Interferon-alpha is an appropriate treatment for people with chronic hepatitis B infection who have detectable virus activity, ongoing liver inflammation, and no cirrhosis. Both conventional interferon and pegylated interferon are approved in the United States. (See "Standard and pegylated interferon for chronic hepatitis B virus infection".)
Interferon-alpha may be considered in young patients who do not have advanced liver disease and do not wish to be on long-term treatment. Interferon-alpha is not appropriate for people with cirrhosis who have liver failure or for people who have a recurrence of hepatitis after liver transplantation.
Interferon is given for a finite duration. Pegylated interferon, a long acting interferon taken once a week, is given for one year. This is in contrast to the other hepatitis treatments, which are given by mouth for many years until a desired response is achieved. Drug resistance to interferon has not been reported.
The disadvantages of interferon-alpha are that it must be taken by injection and it can cause many side effects.
Pegylated Interferon 2005, Lamivudine 1998, Adefovir Dipivoxil 2002,
Entecavir 2005, Telbivudine2006, Tenofovir 2008