Hepatitis B
Treatment Overview
Treatment of hepatitis B viral (HBV) infection depends on how active the virus is and whether you are at risk for liver damage such as cirrhosis. Short-term (acute) hepatitis B usually goes away on its own. Home treatment is used to relieve symptoms and help prevent spread of the virus. In long-term (chronic) HBV infection, treatment includes monitoring the condition and using antiviral medications to prevent liver damage. If hepatitis B has severely damaged your liver, a liver transplant may be considered.
The American Association for the Study of Liver Disease has made recommendations on who should receive antiviral treatment for chronic hepatitis B based on the presence of hepatitis B antigens, level of HBV DNA, and the levels of liver enzymes in your blood.4
Treatment of short-term (acute) hepatitis B infection
Initial treatment for hepatitis B infection depends on whether you:
- Have been recently infected with the hepatitis B virus (HBV).
- Have the symptoms of an acute HBV infection.
- Have chronic HBV infection.
If you believe you have recently been exposed to HBV, you should receive a shot of hepatitis B immune globulin (HBIG) and the first of three immunization shots of hepatitis B vaccine
(What is a PDF document?). It is important to receive this treatment within 7 days after a needle stick and within 2 weeks after sexual contact that may have exposed you to the virus. The sooner you receive treatment after exposure, the more effective treatment is.
If you have the symptoms of acute hepatitis B, treatment with medication is usually not needed. Home treatment usually will relieve your symptoms and help prevent the spread of the virus. To help relieve symptoms and prevent the spread of the infection:
- Slow down. Reduce your activity level to match your energy level. Don't go to work or school unless your workload can be lightened. Avoid strenuous exercise. As you start to feel better, go back to your regular activities gradually.
- Eat right. Even though food may not appeal to you, it is important to get adequate nutrition. For most people, nausea and loss of appetite become worse as the day goes on. Try eating a substantial (but not heavy) meal in the morning and lighter meals later in the day.
- Drink plenty of liquids to avoid dehydration. It is important that you keep your body well-hydrated when you have hepatitis B, especially if you have been vomiting. Drink plenty of water and, if you can tolerate them, drink fruit juices and broth to obtain additional calories. Rehydration drinks help replenish electrolytes.
- Avoid alcohol and drugs. Hepatitis B makes it difficult for your liver to process drugs and alcohol. If you take drugs (prescription or illegal) or drink alcohol when you have hepatitis, their effects may be more powerful and may last longer. In addition, alcohol and some drugs can make liver damage worse. You should avoid alcohol until your health professional feels that your liver is completely healed, which may take as long as 3 to 4 months. Tell your doctor about all of the prescription and over-the-counter medicines you are taking.
- Try to control itching. People with hepatitis B sometimes develop itchy skin. You might try nonprescription medicines, such as Benadryl or Chlor-Trimeton, to control itching. But talk to your health professional before taking any over-the-counter medicines.
- Prevent the spread of HBV by informing people you live with or sleep with about the illness, by not sharing personal toiletries (such as razors and toothbrushes), and by using a condom or abstaining from sex.
For more information on treating the symptoms of acute HBV infection, see the Home Treatment section of this topic.
You may be given medicine to treat an acute hepatitis B infection if:
- Tests continue to detect a certain antigen (HBeAg) after 12 weeks.
- Your liver enzyme levels are higher than normal, indicating that you may have some liver damage.
- The amount of hepatitis B virus DNA is high, which means there is a lot of virus in the body (high viral load).
Treatment of long-term (chronic) hepatitis B infection
If you have chronic HBV infection, treatment depends on how active the virus is in your body and the potential for liver damage. The goal of treatment is to stop liver damage by preventing the virus from multiplying.
Antiviral medication is used if the virus is active and you are at risk for liver damage. Medication slows the ability of the virus to multiply. Antiviral medicine for hepatitis B includes:
- Interferons such as interferon alfa-2b and pegylated interferon alfa-2a.
- Nucleoside reverse transcriptase inhibitors (NRTIs) such as adefovir, entecavir, lamivudine, and telbivudine.
Antiviral therapy is not recommended for everyone who has a chronic hepatitis B viral infection. Your doctor may recommend antivirals if you have or are likely to develop liver damage, such as cirrhosis. For more information, see:
Whether or not you are taking medication, you will need to visit your health professional regularly. He or she will do blood tests to monitor your liver function and the activity of the hepatitis B virus (HBV) in your body. Some of the tests can determine whether HBV is actively multiplying in your liver, which increases your risk of liver damage, such as cirrhosis or liver cancer. If you develop advanced liver damage because of hepatitis and your condition becomes life-threatening, you may need a liver transplant. But not everyone is a good candidate for a liver transplant.
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| Author: | Maria G. Essig, MS, ELS | Last Updated: October 15, 2007 |
| Medical Review: | Kathleen Romito, MD - Family Medicine W. Thomas London, MD - Hepatology | |
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