HEPATITIS B

Patients with chronic HBV have more effective and less toxic options than patients with HCV. We have several

FDA approved oral medications that are well tolerated and are very effective. One pill a day controls it.

Hepatitis B is a more complicated virus to treat than hepatitis C. Patients with Hepatitis B

cannot completely eliminate the virus from their bodies. The goal in treating HBV is to reduce the

HBV-DNA level in the blood to an undetectable level or a very low level. Patients who are positive for

 HBeAg should convert to HBeAb with successful treatment. Very few patients will convert their

HBsAg to HBsAb with antiviral therapy. Very few will permanently eliminate HBV-DNA from their  blood.

If you have chronic HBV, you should see a liver specialist at least every six months. HBV can cause liver

cancer even without severe liver damage. We ask for ultrasounds and AFP every 6 months for patients

with HBV. If a cancer is found, liver transplantation has the best survival. With proper management patients

with HBV can live a normal life.

There are about 1.25 million patients with HBV in the US. Chronic hepatitis B is much less common than

 chronic hepatitis C in the United States. HBV is less predictable than HCV.  About 5% of Americans have

 been infected with HBV and nearly all of them have put the HBV into permanent remission. A person

who has been infected with HBV and has gone into remission has a positive HBcAb total. They have

 undetectable HBV-DNA and test negative for HBsAg. Their ALT and AST are normal. A patient like this

 has an excellent prognosis, and should not have problems unless they become immunosuppressed, for example,

by strong chemotherapy. They have HBV in their liver cell DNA, but no replication of the virus or liver damage.

They do not need treatment.

Patients who did not go into remission have positive HBsAg,  and usually positive HBV-DNA,

sometimes with very high levels. If the viral level is very high, patients are often positive for HBeAg

and negative for HBeAb.  Patients with chronic hepatitis B are at risk of progression to cirrhosis,

liver cancer and premature death. At DDW in Chicago in May 2005, Dr. Chien-Jen Chen and colleagues

showed convincing data that the risk of cirrhosis is related strongly to the the HBV-DNA level in an

 untreated large cohort of patients. Even patients with a very mild elevation of HBV DNA had

 statistically increased risk of cirrhosis compared with patients with undetectable HBV-DNA.

This data suggests that the current treatment guidelines are too conservative and that more patients

should be treated and not just observed. Their data suggested to me that we should be aggressive

in lowering the HBV DNA as much as possible.  The most popular and effective drugs for HBV are

entecavir (Baraclude) and tenofovir (Viread.)

A liver biopsy can be done to measure the damage from HBV, or a test from LabCorp called Fibrosure.

If there is liver damage, I recommend treatment. If the liver tests show no damage, the HBV is usually

observed without treatment.  If there is cirrhosis, I avoid interferon (it can precipitate liver failure) and

use an oral drug (read below). If the damage is mild or moderate, interferon can be used. Read the

 abstract comparing Pegasys to lamivudine.

Lamivudine was the first effective oral medicine for HBV and has been available since December 1998.

It often causes resistance and mutation and is used less and less. HBV DNA may fall to undetectable with

treatment. If you stop treatment after one year, many patients relapse. I like to check patient's HBV DNA levels

and liver tests every 3-6 months to make certain the medication is still working.

Pegasys 180 mcg weekly for 48 weeks is FDA approved for HBV if the patient has mild or moderate liver

damage.