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 in adults clear up 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 pegylated interferon alpha or with pills called nucleoside or nucleotide analogues.

Pegylated 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 the treatment to get the virus back under control. Your doctor should monitor your viral load (hepatitis B 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. If possible, make sure that you will have access to medication for several years before you start treatment with pills.

The World Health Organization has launched Guidelines for the prevention, care and treatment of persons with chronic hepatitis B infection which set out who should be treated and with what drugs. Since the guidelines are aimed at resource limited settings, they do not consider interferon which is more complicated to manage than the nucleoside and nucleotide analogue drugs.