What Every Hepatitis B Patient Should Know
The liver performs many crucial body functions, including:
- storage of vitamins and nutrients
- metabolism of nutrients
- control of glucose levels in the blood
- production of clotting factors
- inactivation of toxic drugs and other chemicals
Get help: Not all people chronically infected with hepatitis B need treatment. However, if your blood levels of ALT are elevated ongoing liver damage may be occurring. Treatment with either lamivudine, adefovir or entecavir (a pill taken once a day) or a course of interferon shots may be appropriate in this situation. These are the only four FDA-approved pills for chronic hepatitis B. Appropriate management can reduce the risk of further liver damage and liver cancer.
Get Informed: People chronically infected with hepatitis B can enjoy completely normal lives, but need to take some necessary precautions. To avoid further liver damage, you should receive the hepatitis A vaccine and avoid drinking alcohol. To prevent transmission to others, do not share toothbrushes, razors, injection or tattoo needles because they may be tainted with blood. Also, ensure that all members of your household are tested and vaccinated if they are not already immunized. If you are uncertain whether your partner is protected, the proper use of latex condoms is recommended. Pregnant women infected with hepatitis B must make sure the newborn receives hepatitis B immunoglobulin (HBIG) plus the first dose of the hepatitis B vaccine at birth, and then follow-up with the second dose at 1-2 months, and the third dose at 6 months. This will be 97% effective in protecting the newborn from becoming a carrier. Take control of your own health, learn about the management and treatments available for hepatitis B. Don't be fooled by advertisements for unproven methods of prevention and treatment.
Blood Tests
Tests to assess whether treatment is indicated: Individuals who are chronically infected with hepatitis B who show evidence of ongoing liver damage associated with high viral activity may be suitable for treatment to reduce the risk of long-term damage that may result in liver damage or failure. The most cost-effective tests useful to assess whether treatment is indicated is ALT and HBeAg. Frequently, treatment of chronic hepatitis B is only considered if ALT is greater than 1.5 times the normal value, and the liver damage is related to high hepatitis B viral activity (positive HBeAg and/or high levels of HBV DNA).
- Alanine Transaminase (ALT): A blood test indicative of active liver damage. If ALT is normal, there is no data to support starting chronic hepatitis B treatment regardless of viral load. For individuals with mild elevation in ALT below a two-fold increase, measurements of ALT at regular 6 months interval is recommended. ALT may also be elevated due to causes other than hepatitis B such as chronic hepatitis C infection, fatty liver, and from drugs and heavy alcohol consumption which are toxic to the liver.
- HBeAg: A positive HBeAg test, in most cases, is a good indicator of high viral load. An exception is in individuals who have mutant strains of the hepatitis B virus and do not secrete HBeAg. This is a much more inexpensive test than some alternative tests and is a widely used marker to monitor the response to treatment. A negative HBeAg reflects low viral activity that does not warrant anti-viral treatment.
- Alpha-fetoprotein (AFP): The alpha-fetoprotein test is used in the screening and diagnosis of liver cancer because AFP is above the normal range in 60-70% of primary liver cancer cases. If the level is greater than 500 (the normal range is usually less than 10), and a tumorous mass is detected on ultrasound or CT scan, the diagnosis of liver cancer can be made without the a biopsy. A rising AFP level is almost always associated with liver cancer. Unfortunately, AFP levels are normal in 30-40% of the liver cancers, in which case cancer can only be detected by finding a mass on ultrasound or CT scan.
Tests to monitor treatment response: Two additional blood tests used to monitor the response to treatment are HBV DNA and hepatitis Be antibody (anti-HBe). Favorable responses to treatment include normalization of ALT, loss of HBV DNA and HbeAg, and anti-HBe seroconversion.
- HBV-DNA: This test directly measures the hepatitis B viral load often expressed as copies per milliliter of blood. A significant drop or loss of HBV DNA levels is a measure of positive response to treatment.
- Anti-HBe: This test is useful in monitoring the response to chronic hepatitis B treatment. An anti-HBe test that turns positive during or after treatment is a marker of a positive response. However, anti-HBe seroconversion may take months or years.
Last Updated: May 9, 2008
