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TREATMENT

There is no specific treatment for acute hepatitis B. Care is aimed at maintaining comfort and adequate nutritional balance, including replacement of fluids that are lost from vomiting and diarrhoea. 4 medications that are currently approved by the Food and Drug Administration (FDA) for treatment of chronic hepatitis B infection.

1. Alfa Interferon

• Interferon is an antiviral agent with antiproliferative and immunomodulatory agent.

• It is given through subcutaneous injection daily or three times per week, for 12-16 weeks or longer.

• Good prognostic factors for response to IFN-a treatment are high levels of aminotransferases, a low viral load, and infection with the wild type.

• Side Effects:

• i. Depression. This is more commonly seen in patients with a prior history of depression.
• ii. Muscle aches, fatigue, and low grade fevers.
• iii. Occasionally, patients may develop low white blood cell count, headaches, irritability, and thyroid dysfunction.
• iv. Underlying autoimmune disorders can be unmasked.

2. Lamivudine

• Inhibits hepatitis B viral DNA synthesis. It acts as a Thymidine analogue that blocks viral replication by competitive inhibition of viral reverse transcriptase.
• It should be taken orally, once daily.
• Lamivudine appears to be effective for patients who do not have a treatment response to Alpha Interferon.
• It is approved for use in adults and children and is usually tolerated well.
• It may cause a rise in the liver enzyme Alanine Aminotransferase, ALT.

3. Adefovir dipivoxil

• Inhibits DNA polymerase activity and reverse transcriptase by competing with the natural substrate deoxyadenosine triphosphate (dATP) and by causing DNA chain termination after its incorporation into viral DNA.

• The efficacy of adefovir dipivoxil has been tested in HBeAg-positive, HBeAg-negative, and lamivudine-resistant patients with encouraging results.

• It is taken orally on a daily basis and is typically well tolerated. The optimal duration of therapy is not yet clear.

• It can be associated with kidney dysfunction, particularly if used in high doses.

4. Entecavir

 

• It is the latest drug approved by the FDA for treatment of chronic hepatitis B.

• It is a Guanosine nucleoside analogue with activity against HBV polymerase. It competes with natural substrate deoxyguanosine triphosphate (dGTP) to inhibit HBV polymerase activity (ie, reverse transcriptase).

• It is less effective for lamivudine-refractory HBV infection

• This drug is taken orally, once daily and the optimal duration of therapy is not yet established.

• Side effects include headache, fatigue, dizziness, nausea, and transient elevation in liver enzymes.

B. In patients with fulminant hepatitis who do not recover and for patients with severe liver dysfunction, a orthotopic liver transplantation (OLT) may be required.