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Friday, November 26, 2010

Hepatitis B part 2

Self-Care at Home
The goals of self-care are to relieve symptoms and prevent worsening of the disease.
*       Drink plenty of fluids to prevent dehydration. Although, broth, sports drinks, gelatin, frozen ice treats (such as Popsicles), and fruit juices may be better because they also provide calories.
*       Ask your physician before taking any medications, even those that are over-the-counter. Some medications depend on the liver, and liver damage may impair the body's ability to metabolize these drugs. If you are on prescription medications, check with your physician to see if the doses should be adjusted or if the medication should be temporarily discontinued.
*       Avoid drinking alcohol until your health care practitioner allows it. Individuals with chronic HBV should avoid alcohol for the rest of their lives.
*       Try to eat a diet that provides adequate nutrition. Take it easy. It may take some time for your energy level to return to normal.
*       Avoid prolonged, vigorous exercise until symptoms start to improve.
*       Call your health care practitioner for advice if your condition worsens or new symptoms appear.
*       Avoid any activity that may spread the infection to other people (sexual intercourse, sharing needles, etc).
Medical Treatment
Acute hepatitis B infection
Acute hepatitis B infection is not treated with antiviral medications.
*       If the infected person is dehydrated from vomiting or diarrhea, a doctor may prescribe IV fluids to help them feel better. Medications may also be used to control these symptoms.
*       People with mild symptoms can be cared for at home.
Chronic hepatitis B infection
The degree of liver damage is related to the amount of active, replicating (multiplying) virus in the blood and liver. Regularly measuring the amount of HBV DNA ('viral load') in the blood gives your physician a good idea of how fast the virus is multiplying. The treatments now in use are classified as antiviral drugs, because they try to stop the virus from multiplying.
*       Antiviral agents, while the best therapy known for chronic hepatitis B, do not work in all individuals with the disease.
*       There are several antiviral agents for chronic hepatitis B approved by the U.S. Food and Drug Administration (FDA). New drugs are always being tested and treatment recommendations are subject to change.
*       Antiviral therapy is not appropriate for everyone with chronic HBV infection. It is reserved for people whose infection is most likely to progress to active hepatitis or cirrhosis.
*       Decisions to start medications for treatment of hepatitis B are made by the patient and health care practitioner, often in consultation with a specialist in diseases of the digestive system (gastroenterologist) or liver (hepatologist).
*       The decision to treat is guided by results of liver function tests, HBV DNA tests, and, frequently, liver biopsies after a complete history and physical examination.
Treatment is usually started when blood tests indicate that liver functions are deteriorating and the amount of replicating HBV is rising. Many people never reach this point. For those who do, the interval between diagnosis and starting treatment is quite variable.
Hepatitis B Medications
All of the following medications described that are used to treat chronic hepatitis B are antiviral medications. They reduce the ability of the virus to reproduce in the body and give the liver a chance to heal itself. These drugs are not a cure for hepatitis B, but they do reduce the damage caused by the virus. Although these medications are similar in some ways, they differ in other important ways. Talk to your health care practitioner about the best medication for you.
Pegylated interferon alfa-2b (Pegasys®)
Pegylated interferon is used alone or in combination with other medications.
*       Pegylated interferon slows the replication of the virus and boosts the body's immune system to fight the infection.
*       It works best in people who have relatively low levels of HBV DNA (low viral load).
*       Pegylated interferon usually is not given to people whose liver damage has progressed to cirrhosis, because it can make the liver damage worse.
*       Treatment is often given for 48 weeks, which is shorter than for other medications, but pegylated interferon requires regular shots (injections) while other medications are taken orally.
*       Pegylated interferon has unpleasant side effects in many people. The side effects are similar to having the flu. For many people, side effects are so severe that they cannot continue taking the medication.
*       Liver function tests and HBV DNA tests are used to check how well the treatment is working.
*       Interferon appears to stop the liver damage in up to 40% of people although relapse is possible.
Nucleoside/nucleotide analogues (NAs)
Nucleoside/nucleotide analogues (NAs) are compounds that mimic normal building blocks for DNA. When the virus tries to use the analogues, it is unable to make new viral particles. Examples of these agents include adefovir (Hepsera®), entecavir (Baraclude®), lamivudine (Epivir-HBV®, Heptovir®, Heptodin®), Telbivudine (Tyzeka®) and tenofovir (Viread®).
*       NAs reduce the amount of virus in the body. Between 20% and 90% of patients may have levels reduced so far that they become undetectable. Obviously, this is a broad range. The higher success rates are achieved in patients who do not have "hepatitis B e antigen" (HBeAg). HBeAg is detected by a blood test and indicates that the virus is actively multiplying.
*       Side effects are less common than with pegylated interferon. NAs have been associated with changes in body fat distribution, reduced blood cell counts, and increased levels of lactic acid in the blood. Rarely, NAs are associated with a severe flare of hepatitis that can be serious or fatal.
*       HBV may become resistant to NAs over time.
*       NAs do not cure the infection. Relapse is possible even in patients who have had a good response to treatment.
There is no surgical therapy for hepatitis B.
If liver damage is so severe that the liver starts to fail, liver transplant may be recommended.
*       Liver transplant is a major process and surgery with an extended recovery period.
*       It also depends on the availability of a matching donor liver.
*       If liver transplant becomes a possibility for an individual, a health care practitioner will discuss the risks and benefits with them.
Hepatitis B Vaccine
There is a vaccine against the hepatitis B virus (Engerix-B, Recombivax HB). It is safe and works well to prevent the disease. A total of 3 doses of the vaccine are given over several months. Hepatitis B vaccine is also produced as a combination product which includes other common childhood vaccinations. This can reduce the number of shots that a child needs at a single visit.
The following groups should be vaccinated for hepatitis B:
*       All children younger than 19 years, including all newborns - especially those born to mothers who are infected with HBV
*       All health care and public safety workers who may be exposed to blood
*       People who have hemophilia or other blood clotting disorders and receive transfusions of human clotting factors
*       People who have end-stage renal disease including those who require hemodialysis for kidney disease
*       Travelers to countries where HBV infection is common. This includes most areas of Africa, Southeast Asia, China and Central Asia, Eastern Europe, the Middle East, the Pacific Islands, and the Amazon River basin of South America.
*       People who are in prison
*       People who live or work in residential facilities for developmentally disabled persons
*       People who inject illegal drugs
*       People with chronic liver disease such as hepatitis C
*       People who have multiple sex partners or have ever had a sexually transmitted disease
*       Men who have sex with men
*       Persons with HIV
*       People who have a sexual partner who is an HBV carrier.
*       Household contacts of persons who are carriers of HBV.
*       Anyone who wants to be vaccinated, regardless of risk factors.
    Hepatitis B immune globulin (BayHep B, Nabi-HB) is given along with the hepatitis B vaccine to                                                          unvaccinated people who have been exposed to hepatitis B.
*       These include close contacts of people with HBV infection, health care workers who are exposed to HBV-contaminated blood, and infants born to mothers infected with HBV.
*       Giving the immune globulin and the vaccine together in these situations prevents transmission of the disease in 80% to 90% percent of cases.
Hepatitis B Prevention
    In addition to the hepatitis B vaccine, other ways to protect yourself from HBV infection include:
*       If you are sexually active, practice safe sex. Correct use of latex condoms can help prevent transmission of HBV, but even when used correctly, condoms are not 100% effective at preventing transmission. Men who have sex with men should be vaccinated against both hepatitis A and hepatitis B.
*       If you inject drugs, don't share needles or other equipment.
*       Don't share anything (including grooming products) that might have blood on it, such as a razor, toothbrush, fingernail clippers, etc.
*       Think about the health risks if you are planning to get a tattoo or body piercing. You can become infected if the artist or person piercing you does not sterilize needles and equipment, use disposable gloves, or wash hands properly.
*       Health care workers should follow standard precautions and handle needles and sharps safely.
*       If you are pregnant or think you might be pregnant, tell your health care practitioner if you have any of the risk factors for HBV infection
Hepatitis B Prognosis
                        Some people rapidly improve after acute hepatitis B. Others have a more prolonged disease course with very slow improvement over several months, or with periods of improvement followed by worsening of symptoms. A small group of people (about 1% of infected people) suffer rapid progression of their illness during the acute stage and develop severe liver damage (fulminate hepatitis). This may occur over days to weeks and may be fatal.Other complications of HBV include development of a chronic HBV infection. People with chronic HBV infection are at further risk for liver damage (cirrhosis), liver cancer, liver failure, and death.

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