People who have immunity and normal liver function tests do not need treatment. People who are chronically infected but do not have any liver damage also do not need treatment but need close monitoring with regular (6 monthly) liver function tests. However, if a person has liver damage they should consider having treatment for hepatitis B. The decision on when to start treatment is complex and should be made in consultation with a gastroenterologist with an interest in hepatitis B.
The Australian Government through the Pharmaceutical Benefits Scheme funds several different medications to treat chronic hepatitis B. The most common are anti-viral medications taken as tablets each day for a year or longer. A less common form of treatment is with interferon.
Hepatitis B treatment is suitable for people who are classified as being in a particular stage of hepatitis B infection, which is characterised by:
- increased virus activity and liver inflammation demonstrated by elevated liver enzymes (ALT)
- inflammation and activity in the liver as seen in the results of a liver biopsy, and
- high levels of hepatitis B virus (HBV DNA) in the blood.
Treatment aims to stop the hepatitis B virus from multiplying, or to reduce the rate of multiplication as much as possible. This decreases the risk of serious liver disease developing later in life and makes it possible for the liver to repair some of the damage and to work better. It is very rare that any of these medications will cure hepatitis B infection.
Treatment side effects
The main side effect of the antiviral tablets (e.g. the medicines Lamivudine, Adefovir and Entecavir) is sometimes the hepatitis B virus mutates (changes) during the course of treatment, which means the antiviral tablets are not as effective against the new form of the virus. This is called antiviral resistance. During treatment, the patient’s blood tests are monitored very carefully to look for signs of antiviral resistance. If there are signs of resistance such as elevated liver enzymes and high levels of hepatitis B virus in the blood, the antiviral tablets will be changed.
Keefe, E.C., Dieterich, D., Han, S-H. et al. (2004). ‘A treatment algorithm for the management of chronic hepatitis B virus infection in the United States’. Clinical Gastroenterology and Hepatology. 2, pp.87–106.