Prevention, Diagnosis & Treatment

Prevention

The hepatitis B virus (HBV) is spread between people through contact with the blood or other body fluids (i.e. saliva, semen and vaginal fluid) of an infected person. The hepatitis C virus (HCV) is spread through direct contact with infected blood. Very rarely it may be passed on through other body fluids.

Many people do not have any symptoms if they contract hepatitis B or C, although they can still transmit the viruses to others. The most common routes of infection are:

• Blood transfusions and blood products using unscreened blood (in most countries, but not all, blood has been screened since about 1990)
• Medical or dental interventions without adequate sterilisation of equipment
• Mother to infant during childbirth
• Sharing equipment for injecting drugs
• Sharing straws, notes etc. for snorting cocaine
• Sharing razors, toothbrushes or other household articles
• Tattooing and body piercing if done using unsterilised equipment

In the case of hepatitis B, infection can also occur through having unprotected sex with an infected person. If you think you could have been at risk from either hepatitis B or C, it is important to get tested.

Getting immunised is the best way of preventing hepatitis B infection. More than one billion doses of the hepatitis B vaccine have been used since the early 1980s and it has been shown to be effective in approximately 95% of cases. There is currently no vaccine for hepatitis C.

Diagnosis

To diagnose hepatitis B the blood needs to be checked for the HB surface antigen (HBsAg).  The HBs antigen is a part of the virus and will usually appear in your blood six to twelve weeks after infection.  If the test is positive, you have hepatitis B. In that case, your doctor should conduct further tests to check if your hepatitis B infection is new or old, if it is harming your body or not, and if you need treatment or not. If you have naturally cleared the virus, or if you have been vaccinated against hepatitis B, you will have antibodies to hepatitis B (anti-HBs). Your body made these to destroy the virus. It is good to have anti-HBs, because that means you are protected against future infection by the hepatitis B virus.

For hepatitis C, your doctor will first check for HCV antibodies (anti-HCV). If the test is positive, this means you either have the virus now, or have had the virus and cleared it. Hepatitis C antibodies usually take seven to nine weeks to appear in your blood after infection. If your immune system is weakened (e.g. by HIV) your body may take longer to produce HCV antibodies, or it may not produce any at all. If the first test is positive, your doctor will then test for the virus itself (HCV RNA). If this is positive, you have hepatitis C.

If you are diagnosed with hepatitis B or C you will face many challenges, but it is better to confront the disease head on, know how to avoid transmitting the infection to others and consider your treatment options and self-management strategies as early as possible.

For further information about whether you might be, or have been, at risk and how you can get tested, please contact your local patient group, who will be able to provide you with the information that you need.

Hepatitis B Treatment

Acute hepatitis B: it is not usually necessary to treat a new hepatitis B infection in the first six months. Nine out of ten new infections go away on their own, with or without treatment. In this early stage of disease, treatment makes very little difference to the chances of a cure. Antiviral drugs may only be necessary and helpful in rare cases, if the acute infection causes very aggressive liver inflammation.

Chronic (long-lasting) hepatitis B: consult with your doctor about your situation. Some people need treatment, while others should wait. Treatment does not usually cure you of hepatitis B, but it can turn an ‘aggressive’ hepatitis B infection into a mild infection. This can stop the liver from being damaged. If the infection is considered mild, it might be better to monitor it and wait until later for treatment. You can treat chronic hepatitis B with peg-interferon or with pills, which are called nucleoside or nucleotide analogues.

Peg-interferon alfa comes in a syringe and stimulates the immune system against the virus. This treatment may have side effects, such as fatigue, flu-like symptoms, depression, skin and hair problems and changes in blood chemistry, amongst others. Treatment continues for 24 to 48 weeks and while not all hepatitis B patients respond well to interferon, certain types of hepatitis B infection do.  For example, patients with genotype A, HBeAg positive, with elevated liver enzymes but NO cirrhosis can often successfully reduce their viral infection to a milder state. Your doctor needs to monitor your interferon treatment closely. Interferon treatment should not be used if you already have cirrhosis of the liver.

Nucleoside and nucleotide analogues come in pills. They stop the virus from replicating. The pills have very few side effects, and even patients with cirrhosis can take them. However, patients need to take their pills every day, for several years and sometimes a lifetime. If the virus becomes resistant to one type of pill, it might stop working, and another, different drug will need to be added to their treatment to get the virus back under control. Your doctor should monitor your viral load (HBV DNA) to make sure that your treatment works. Do not forget to take your pills, even if you feel well. If you miss many doses or stop treatment too early, the disease might become worse than it was before. Make sure that you will have access to medication for several years before you start treatment with pills.

Hepatitis C Treatment

In many countries, the second quarter of 2011 marked the arrival of a new current standard of care for people with HCV genotype 1; Boceprevir (Victrelis) and Telaprevir (Incivek), which are protease inhibitors taken orally and added to the Pegylated interferon alfa and ribavirin combination treatment, have been launched in different countries given their significantly higher success rates.

Pegylated interferon alfa and ribavirin: this is still being used as first line therapy choice for HCV patients with genotypes 2,3,4,5 and 6. It is also being used to treat HCV genotype 1 patients in countries where the new protease inhibitors have not been approved yet or where decisions on how to commission the drugs have not been taken yet.
Pegylated interferon alfa and ribavirin cures approximately half of all hepatitis C patients. A patient is considered to be cured if there is no virus in the blood six months after the end of treatment. This is different from hepatitis B therapy, which controls rather than cures the infection. Interferon comes in a syringe and ribavirin is available in pills. The treatment may have side effects such as fatigue, flu-like symptoms, depression, hair and skin problems, and changes in blood chemistry. Therefore, treatment should be monitored by an experienced doctor or clinic. The duration of treatment is different from patient to patient. You usually need 24 to 48 weeks of treatment, but in some cases, 72 weeks may be recommended. There are several subtypes of the hepatitis C virus, which are called genotypes. They do not seem to influence the course of the disease, but they respond differently to treatment. Patients infected with genotypes 1, 4, 5 and 6 are more difficult to cure than those infected with genotypes 2 and 3.
There are a number of new hepatitis C treatments that are in development.

We will be updating this section with information about the first generation of these drugs (boceprevir and telaprevir), as well as information about the new developments very shortly!